Prevalence of Cryptosporidium Patvum in Patients with chronic Diarrhoea in Hoima District; Uganda

Chronic diarrhoea was defined as 2 or more unusually loose stools daily for at least a month. For each patient; a single stool specimen was collected and concentrated with formal- ether concentration method. Two air dried thin smears were then stained by a modified Kinyoun method for cryptosporidium. One observer (M.R) did all the microscopy. Cryptosporidium oocytes were detected in 36of AIDS patients (Chi-square test and P respectively) although cryptosporidium is found 8 times more in AIDS patients. There is also a high frequency of asymptomatic cyst-passers in this area among AIDS patients but not in the healthy controls. Cryptosporidium parvum is a well known opportunitic infection in AIDS patients with diarrhoea although it is now recognised as a frequent cause of diarrhoea in otherwise healthy humans as well. Investigations for cryptosporidium infection in Africa have mainly focused on AIDS patients with chronic diarrhoea and it has been found frequently in such patients; at a prevalence rate varying from 4to 48. The aim of this study was to assess and compare the prevalence of cryptosporidium in four groups: 1. AIDS patients with chronic diarrhoea (50 cases). 2. AIDS patients without diarrhoea (50 cases)

Diagnosis and Treatment of Infectious and Cryptogenic Diarrhoea in Patients with AIDS

Chronic diarrhoea is a common complication in HIV-infected patients. With an overall frequency of 30to 90. In the majority of cases a specific pathogen can be identified; but in 15-35of patients the diagnostic evaluation is unrewarding. Although many explanations have been proposed; the mechanisms of cryptogenic diarrhoea remains still uncertain. A stepwise diagnostic work-up is generally recommended; but the necessity of performing invasive procedures; such as gastrointestinal endoscopy and co-lonscopy; is contraversial stoll studies however; do not permit the detection of all treatable pathogens. Thus; for patients with persistent diarrhoea whose stool cultures and parasitologic examination are negative a comprehensive diagnostic evaluation seems advisable. From January 1990 to December 1992; we observed 130 patients with chronic diarrhoea out of a total of 374 AIDS patients (34.8). Enteric pathogens were identified in 90 patients (69.2). The frequency distribution was as follows: Cryptosporidium spp 68.9; Giardia lambia 21.1. Cryptomegalovirus 13.3; Salmonella ssp. 10; Mycobacterium avium complex 3.3; Isospora belli 2.2; Clostridium difficile 2.2. Mixed infections were present in 13.1of patients. The pathogenic role of Microsporidia however; could not be evaluated since electron microscopic examination was not performed in all cryptogenic cases. specific treatment is always preferable to empiric antimicrobial therapy; considering the variety of infectious agents and the high incidence of mixed infections. Patients with diarrhoea due to pathogens for which effective antimicrobial treatment is lacking and refractory to anti-motility agents may benefit from therapy with somatostatin analogues; although temporarily