Prevalence of Intestinal Coccidianparaste and Associated Risk Factors Among Diarrhogenic HIV Infected Patients on Art in ASELLA and ADAMA Teaching Hosptals,Ethiopia.
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Date
2018-01
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Addis Ababa University
Abstract
Background: Intestinal coccidian parasitic infections are one of the major causes for diarrheal diseases in HIV-positive patients particularly for those with low CD4 counts. However, oocysts of intestinal coccidian parasites are mostly miss-diagnosed and under-reported as the routinely practiced wet mount stool examination is not able to detect them Investigation with coccidian staining techniques may allow correct diagnosis and treatment that may help to prevent complications.
Objectives: The objective of this study was to determine the prevalence of intestinal coccidian parasites and associated risk factors among diarrhogenic HIV positive patients on ART.
Methodology: Institutional based cross sectional study was conducted among HIV patients with diarrhea who attended the ART clinic of Asella and Adama Teaching Hospitals. During the data collection period from March 30, 2018 to August 15, 2018, Ethiopia, a total of 222 diarrhogenic HIV positive participants were included in the study. Stool samples were collected and examined in Asella Hirsch Institute of Tropical Medicine for parasites using direct smear, ParasiTrap® stool concentration technique, Modified Z-N and Auramine O staining techniques. Structured questionnaire was used to collect data on socio demographic and associated risk factors. Data was entered and analyzed using SPSS version 21 software. Logistics regressions were applied to assess any association between independent and dependent variables. Kappa value was used for method evaluation and P values < 0.05 were taken as statistically significant value.
Results: The prevalence of intestinal coccidian parasites were 22/222 (9.9%) in HIV infected patients on ART and were associated with CD4+ T-cell count <200 cells/µl [AOR, 95% CI: 10.4 (38.88, 2.8), P<0.05]. The cumulative prevalence of intestinal parasitic infection among HIV infected individuals on ART in the study populations were 18.92 % (42/222). The most prevalent
parasite were E.histolytica (6.75%), followed by cryptosporodium species and Isospora belli (4.95%),G.lamblia (2.25%) and Taenia species (0.45%).The agreement between Modified ZN and Auramine O was found to be 0.643. Taking Auramine O as gold standard, the sensitivity and specificity of Modified ZN were 50% and 100% respectively.
Conclusions: Intestinal Coccidian parasites are frequent opportunistic intestinal parasites infecting HIV infected patients. A lowered CD4 count predisposes to acquisition of these agents. Regular monitoring of CD4 counts and screening for these opportunistic agents in the HIV infected will help reduce the mortality and morbidity associated with infections by these agents.
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Keywords
Diarrhea, Intestinal coccidian parasite, ART, Ethiopia.