Identification of opportunistic enteric parasites among immunocompetent patients with diarrhoea from Northern India and genetic characterisation of Cryptosporidium and Microsporidia.

Purpose: Enteric parasitic infestation is a major public health problem in developing countries. Parasites such as Cryptosporidium spp., Cyclospora spp., Cystoisospora spp. and Microsporidia may cause severe diarrhoea among immunocompromised patients. There is scanty data on their frequency among immunocompetent patients. Accordingly, we studied the frequency of enteric opportunistic parasites among immunocompetent patients with diarrhoea from northern India; we also performed genetic characterisation of Cryptosporidia and Microsporidia among them. Patients and Methods: Stool samples from 80 immunocompetent patients with diarrhoea, and 110 healthy controls were examined. Parasites were detected by direct microscopy, modified acid-fast (Kinyoun’s) and modified trichrome stain. Polymerase chain reaction – restriction fragment length polymorphism was used for genetic characterisation of selected species such as Cryptosporidia and Microsporidia. Results: Enteric parasites were detected in 16/80 (20%) patients (mean age 28.8 ± 20 years, 45, 56% males) and in 2/110 (1.8%) healthy controls (P = 0.00007). Parasites detected were Cryptosporidium spp. (8/16, 50.0%), Cystoisospora spp. (4/16, 25%), Microsporidia (1/16, 6.25%), Cyclospora spp. (1/16, 6.25%) and Giardia spp. (1/16, 6.25%). One patient had mixed infection with Cystoisospora spp. and Giardia spp. The species of Cryptosporidia and Microsporidia detected were Cryptosporidium hominis and Enterocytozoon bieneusi, respectively. Parasites were more often detected in younger patients (≤20 years of age) than in older. Most of the parasite infected patients presented with chronic diarrhoea. Conclusion: Opportunistic enteric parasitic infestation was more common among immunocompetent patients with diarrhoea than healthy subjects. Special staining as well as molecular methods are essential for appropriate diagnosis of these parasites.

Intestinal Parasitic Infections among HIV/AIDS Patients with Diarrhoea at Rural Tertiary Care Teaching Hospital Of Maharashtra.

Background and Objective: Opportunistic intestinal parasites usually cause mild and self- limiting infections in immunocompetent individuals but in the case of people living with HIV/AIDS (PLHA) they cause severe, chronic or frequent gastrointestinal disease. The spectrum of intestinal parasites causing infections in PLHA varies from country to country and region to region within the country. Therefore it is very necessary to know the relative frequencies of specific intestinal parasites causing diarrhoea in PLHA in different regions of the country to devise appropriate management strategies. The present study was conducted with an aim to document the prevalence pattern of various intestinal parasites in PLHA in rural tertiary care teaching hospital of Maharashtra. Methods: Stool samples collected from HIV infected individuals with diarrhoea were screened for the presence of intestinal parasites by standard parasitological protocol. Results and Interpretation: The incidence of HIV infection was high in age group 26-35 years followed by 16-25 years age group. The incidence of HIV infection was high in males as compared to females. Out of 124 stool samples screened, 44 (35.48%) showed presence of intestinal parasites. Cryptosporidium parvum followed by Entamoebahistolytica and Isospora belli were the most common intestinal parasite. Conclusion: Opportunistic intestinal parasitic infections still pose as a problem in rural parts of India. This underscores the importance of screening of stool samples of PLHA. It can be also suggested that along with prompt diagnosis and treatment of opportunistic infection, clean potable water supply, improved sanitation and health education is necessary for preventing opportunistic infection in PLHA.

Spectrum of opportunistic infections in human immunodeficiency virus infected patients.

Background & Objectives: Opportunistic infections are common complication seen in HIV infected patients. The type of pathogens responsible for OIs varies from country to country and even from region to region within the same country. Therefore it is important to know the relative frequencies of specific OIs in different parts of the country for appropriate management strategies. This study was designed with an aim to document the pattern of opportunistic infections in HIV infected patients. Methods: The study included 152 HIV positive patients. Depending on the patient’s clinical features, specimens were collected and processed as per standard microbiological protocol for demonstration or isolation of pathogens. Results: In the present study, out of 152 HIV infected patients, 92(60.5%) were males and 60(39.5%) were females. Opportunistic infections were noted in 106 (69.7%) patients. Mycobacterium tuberculosis was the most common bacterial pathogen. Cryptosporidium parvum followed by Isospora belli and Entamoeba histolytica were the major parasites demonstrated in stool of HIV infected patients. Candida spp. was the predominant mycotic pathogen. Conclusion: In HIV infection opportunistic infections account for a considerable proportion of mortality and morbidity. It also necessitates toxic and expensive therapies. The early diagnosis and adequate management of opportunistic infections can slow down the progression to AIDS and need for antiretroviral therapy.