Intestinal microsporidiosis among HIV/AIDS patients receiving antiretroviral therapy in Sana’a city, Yemen: first report on prevalence and predictors

Abstract

Background Intestinal microsporidiosis is an opportunistic infection associated with persistent diarrhea among HIV/AIDS patients. In Yemen, however, its epidemiology is unknown. Therefore, this study determined its prevalence and predictors among HIV/AIDS patients receiving antiretroviral therapy (ART) in Sana’a city, the capital of Yemen. Methods This cross-sectional study included 402 patients receiving ART at Al-Jomhori Educational Hospital in Sana’a from November 2019 to December 2020. Data about demographics, clinical characteristics and risk factors were collected using a pre-designed questionnaire. Stool samples were collected and examined for microsporidian spores using the Gram-chromotrope Kinyoun staining. Blood samples were also collected and used for CD4 cell counting by flow cytometry. Univariate analysis was used to test the association of patients’ characteristics and risk factors with intestinal microsporidiosis. Multivariable logistic regression was then used to identify the independent predictors of infection. Statistical significance was considered at P-values < 0.05. Results Intestinal microsporidiosis was prevalent among 14.2% (57/402) of HIV/AIDS patients and was significantly associated with diarrhea (OR 3.4, 95% CI 1.7–6.6; P = 0.001). The significant independent predictors of infection were < 200 CD4 cells/µl (AOR 3.2, 95% CI 1.5–6.9; P = 0.003), not washing hands after contacting soil (AOR 2.5, 95% CI 1.1–5.4; P = 0.026) and before eating (AOR 3.1, 95% CI 1.5–6.4; P = 0.003), eating unwashed raw produce (AOR 2.5, 95% CI 1.2–5.3; P = 0.017) and absence of indoor latrines (AOR 6.2, 95% CI 1.5–25.9; P = 0.012). Conclusions The prevalence of intestinal microsporidiosis among HIV/AIDS patients in Sana'a is high and comparable to that reported from several other countries, being prevalent among approximately 14.0% of patients and significantly associated with diarrhea. It could be predicted among patients who have < 200 CD4 cells/µl, have poor hand hygiene after contacting soil and before eating, usually eat unwashed raw produce, or do not possess indoor latrines. Large-scale studies on its epidemiology and predictors among HIV/AIDS patients across the country are warranted.

Detección de Microsporidios y factores asociados en pacientes VIH positivos con síndrome diarreico en el Hospital “Dr. José Daniel Rodríguez”, Guayaquil-Ecuador, 2021-2022

“…En Saná capital de Yemen en Asia en el 2020 estudiaron a 402 pacientes VIH/SIDA, asociados con diarrea, determinándose una prevalencia de microsporidios del 14,2% (57/402), se analizaron muestras de heces utilizando la tinción de Gram Cromotropo para identificar esporas de microsporidios de color azul rosado con estructuras parecidas a un cinturón de color azul, además se analizó muestras de sangre para el contaje de células CD4+ con un resultado < 200 células xml 3 (24) .…”

Human Microsporidiosis: A Narrative Review of Serodiagnostic Tests

“…Accurate estimation of the prevalence of human infection has not been possible due to difficult detection. Human infections have been reported from all continents except Antarctica (9). Microsporidia infections had been rarely identified before the AIDS pandemic (10).…”

Microsporidia in HIV-Positive and HIV-Negative Pediatric Patients with Diarrhea at a Tertiary Care Hospital

“…of 8 genera widely infect humans with Enterocytozoon bieneusi and the Encephalitozoon spp among the most common microsporidia causing diarrhea and systemic diseases. 12 13 14 Intestinal microsporidiosis was prevalent among 14.2% of HIV/AIDS patients and was significantly associated with diarrhea (odds ration [OR] 3.4). 12 The prevalence of microsporidia in humans ranges from 1 to over 50%, depending on the geographic region, the methods applied for diagnosis, and demographic characteristics of the studied population.…”

“… 12 13 14 Intestinal microsporidiosis was prevalent among 14.2% of HIV/AIDS patients and was significantly associated with diarrhea (odds ration [OR] 3.4). 12 The prevalence of microsporidia in humans ranges from 1 to over 50%, depending on the geographic region, the methods applied for diagnosis, and demographic characteristics of the studied population. 13 At a national level, in India there is scanty data on microsporidial infections in HIV-positive pediatric patients.…”