Abstract

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From May to December, 2006, stool samples from 900 patients attending four hospitals in Abuja, Nigeria were collected and examined for the presence of intestinal protozoan. The aim of the study was to determine if correlation exists between intestinal protozoan infection and diarrhea in HIV/AIDS patients. Of the 900 individuals sampled, 700 were HIV seropositive while 200 were seronegative. A significant difference (P.
KEYWORDS: Intestinal protozoan, HIV/AIDS, Diarrhea, Abuja-Nigeria.

Introduction

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The World Health Organization (2006) defines diarrhea wasting syndrome along with a positive HIV serology test to be an AIDS defining illness. The etiology of such diarrhea could either be parasitic, bacteria, fungal, enteric virus or HIV itself. (Soave and Framm, 1997).
Diarrhea has been reported to be one of the most common presenting complaints in HIV-infected individuals with the infections etiological agents including both opportunistic agents that consistently cause severe, chronic or frequent gastrointestinal disease and non-opportunistic agents that usually cause acute, treatable diarrheal illness (Smith et. al. 1998). Opportunistic infections constitute a major health problem in patients infected with HIV with intestinal parasitic diseases as the commonest and are a major cause of morbidity and mortality in HIV positive individuals worldwide. (Chaisson et. al. 1998).
Several species of protozoan have been associated with acute and chronic diarrhea in HIV disease. The most commonly reported include Cryptosporidium parvum, Isospora belli, Microsporidium species, Giardia intestinalis, Entamoeba histolytica and Cyclospora spp (Gupta et. al. 2008).
Diarrhea is a major gastrointestinal symptom in HIV infection affecting 90% of patients and it becomes more frequent as immunodeficiency progress. Diarrhea and weight loss are independent predictors of mortality (Sharpstone et. al. 1999). Gastrointestinal involvement in HIV/AIDS is almost a universal and significant disease occurring in 50-90% of patients while diarrhea can be a presenting manifestation or a life threatening complication in HIV patients sometimes during the course of the disease. (Awole et. al. 2003).
Much attention is currently being focused on the detection of specific pathogens as cause of diarrhea in HIV patients since its correct treatment could improve the patients general well being (Caraballo et. al. 2001). This study therefore aims to incriminate the protozoan and investigate the correlation between parasitic protozoan infection and diarrhea in Abuja Nigeria. However, the study was limited in that it never graded diarrhea into acute or chronic and also financial constraints never allowed for CD4+ T-cell count.

Materials and Methods

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The study was conducted between May-December 2006 in 3 secondary health facilities (Asokoro District Hospital, Maitama District Hospital and Wuse General Hospital) and one tertiary health facility (National Hospital) all in Abuja, the Federal Capital Territory of Nigeria located at latitude 90 41 60N and longitude 70 311 60E. It has an undulating terrain and 3 marked weather conditions of rainy season, dry season and a brief interlude of harmattan. The total annual rainfall ranges between 1100mm and 1600mm. The average annual temperature ranges between 27 oC- 30 oC.
Ethical clearance: The ethical clearance committee of the various centres approved the study: REF/FCDA/HHSS/MDH/GEN/155/I (for Maitama District Hospital); REF/FCTA/HHSS/ADH/GEN/99/Bol./II/263 (for Asokoro District Hospital; REF/FCTA/HHSS/WGH/EST/4/VOL.II (for Wuse General Hospital) and the National Hospital Abuja. Informed consent was obtained from volunteers and questionnaires administered to them according to the various hospital guidelines.
Subject selection and sample collection: 900 persons were studied comprising 700 HIV – seropositive and 200 HIV seronegative patients (whom we assume are normal and have no HIV). Samples from the seronegative patients were used as control. Stool samples were collected from patients within a period of 24 hrs and taken to the laboratory for processing and examination. Specimens that could not be processed immediately were preserved in 10% formalin to prevent bacterial action (Mohandas et. al., 2002).
Examination of samples
Amoebae, flagellates and ciliates -were identified using the formal-ether concentration method (Markell et. al., (1986). It was specifically done for the identification of amoebae viz: Blastocystis hominis, Entamoeba histolytica, Entamoeba coli, Giardia lamblia and Balantidium coli.
Euccocidians- Modified Ziehl Neelson (Z-N) staining method was employed for the identification of Euccocidians. It was done for the identification of Cryptosporidium parvum, Cyclospora cayetanensis and Isospora belli.
Microsporidium- were identified using the modified Giemsa stain technique of Markell et. al. (1986) and specifically used for the detection of Enterocytozoon bieneusi.
Statistical Analysis: All data’s were analyzed statistically using chi-square.

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Source(s) of Funding

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Personal Funding for research work

Competing Interests

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No Competiting interests among authors

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