Intestinal Protozoa in Immunosuppression: A Medical Hassle

Abstract

Introduction: Immunity forms the backbone of our very existence and opportunistic infections have plagued the immunosuppressed since long. A significant morbidity and mortality is attributable to intestinal parasitosis in the immunocompromised population. Objectives:This study aims to study the prevalence of intestinal protozoa in various immunosuppressed groups and to correlate degree of immunosuppression with protozoal infections. Material and Methods:The study was conducted on 400 patients divided into 4 groups: Group I (HIV patients), Group II (patients on chemotherapy/chemotherapy and radiotherapy for various malignancies), and Group III (diabetes patients) and Group IV included children presenting with diarrhea. Group I, II and III included patients with and without gastrointestinal symptoms. Stool samples were investigated microscopically for cysts/trophozoites after concentration with formol-ether method. Iodine wet mount and Modified acid fast staining methods were used. Result:Intestinal protozoa were detected in 40.75% (163/400); more commonly in patients with higher degree of immunosuppression (CD4 count <200/µl in HIV patients: 62.5%, malignancy patients on both chemotherapy and radiotherapy: 71.1%, higher levels of HbA1c >7: 95.3% in diabetics and moderate to severe malnutrition: 61.8%. Most common protozoa associated was Cryptosporidium in 66 patients (40.5%) followed by, Entamoeba histolytica in 48 (29.4%), Giardia lamblia in 35 (21.5%), Isosporabelliin 9 (5.5%), Blastocystis hominis in 4 (2.5%), Cyclospora cayetenensis in 1 (0.61%). Conclusion:High prevalence of intestinal protozoa was seen in all groups of immunosuppressed patients and a significant association seen between degree of immune suppression and protozoal infection. Focus needs to be on routine screening of all immunosuppressed patients and their immune reconstitution.

Prevalence of intestinal protozoan infections among individuals living with HIV/AIDS at Felegehiwot Referral Hospital, Bahir Dar, Ethiopia

“…22 Furthermore, the present finding is comparable with the prevalences of 25.3%, 16.8%, and 15% reported from Mexico, Malaysia, and India, respectively. [26][27][28] The present finding, however, was relatively higher (19.3%) compared to the prevalence rate of 10.3% observed among individuals living with HIV/AIDS in a teaching hospital in Jimma, southwest Ethiopia. 29 The prevalence of giardiasis in the present study was 4.3%.…”

“…The association between the CD4+ T-cell count and intestinal protozoa infection has also been reported in previous studies from Ethiopia, India, Malaysia, and Senegal. 20,27,28,33 Most of the socio-demographic features in the present study were not statistically significant as predictors of the manifestations of enteric protozoan infection among individuals living with HIV/ AIDS. Demographic variables such as age, sex, location of residence, marital status, work status, monthly income, and level of education were not implicated as determinants of the occurrence of enteric protozoal infection among the study subjects.…”

Intestinal Parasitic Prevalence in Human Immuno-Deficient Virus (Hiv) Infected Patients With and Without Diarrhoea and Its Association With Cd4 T Cells Counts

“…Recently Malaji et al from Baglkot and Venkatesh Naik R et al from Karnataka and Vyas et al from Jaipur have documented parasitic prevalence in diarrhoeal cases i.e. 44%, 21.8% and 60.9% respectively 9,22 . In all these studies C.parvum was found to be most common pathogen 9,17,18 .…”

“…Further the study tried to determine the association between intestinal parasites in diarrhoeal and non -diarrhoeal patients infected with HIV at different levels of immunosuppression by means of CD4 T cell count. CD4 counts play an incredibly important role in the presentation of diarrhoea as well as in the control of protozoa in HIV-infected individuals 22 . The impairment of the immune system in HIV patients makes them extremely vulnerable to the specific opportunistic infections which are unable to establish in immunocompetent hosts 22 .…”

“…CD4 counts play an incredibly important role in the presentation of diarrhoea as well as in the control of protozoa in HIV-infected individuals 22 . The impairment of the immune system in HIV patients makes them extremely vulnerable to the specific opportunistic infections which are unable to establish in immunocompetent hosts 22 . In our study, intestinal parasites were more commonly found in patients with CD4 count 200-499 cells/µl and the correlation between CD4 cell count and intestinal parasitic infection was found to be highly significant (p<0.01).…”