A Study of Parasitic and Bacterial Pathogens Associated with Diarrhea in HIV-Positive Patients

Abstract

IntroductionDiarrhea is a common complication of acquired immune deficiency syndrome (AIDS), occurring in almost 90% of AIDS patients in developing countries like India. The present study was aimed to determine the prevalence and microbiological profile of pathogens associated with diarrhea in human immunodeficiency virus (HIV) positive patients and their relation to CD4 counts.Materials and methodsForty-five successive HIV-positive patients, 27 with diarrhea (study group) and 18 without diarrhea (control group), were included in the three-month study. The HIV infection was confirmed by three different antibody detection tests. The stool samples were collected on two consecutive days and were examined for parasites by microscopy using wet mount and modified Ziehl-Neelsen stain. They were examined for bacteria by Gram stain and conventional Ziehl-Neelsen stain and were inoculated on appropriate culture media. The isolates were identified by standard biochemical tests, followed by antibiotic susceptibility testing using the Kirby-Bauer disc diffusion method.Results Twenty-four pathogens were detected in diarrheal HIV-positive patients, including 14 parasites (58.33%), seven bacteria (29.17%), and three fungi (12.50%). Isospora sp. was the most common parasite (25.9%) followed by Cryptosporidium sp. (14.8%). Other parasites included Cyclospora sp., Strongyloides stercoralis, and Entamoeba histolytica (3.7% each).​ Escherichia coli (18.5%) was the most common bacterial isolate, of which, 80% were Enterotoxigenic E. coli (ETEC) while 20% were Enteropathogenic E. coli (EPEC). Other isolates included Shigella flexneri and Mycobacterium tuberculosis (3.7% each). The isolates were sensitive to furazolidone (94.11%), chloramphenicol (76.47%), and gentamicin (52.94%). The isolates from diarrheal patients showed resistance to norfloxacin (5.88% vs. 50%, p<0.05) as compared to those from non-diarrheal patients. The diarrheal HIV-positive patients had lower mean CD4 counts (202.6 cells/µL), as compared to those without diarrhea (239.28 cells/µL).Conclusion Isospora sp. is the most common parasite and Escherichia​ coli is the most common bacterium associated with diarrhea in HIV patients. The antibiotic sensitivity patterns should be monitored regularly to detect resistance to commonly used drugs. The prevalence of organisms in a region, various clinical manifestations, sensitivity patterns of isolates, and relation with CD4 count should be considered while instituting therapy in HIV patients with diarrhea.

Prevalence of enteric pathogens, intestinal parasites and resistance profile of bacterial isolates among HIV infected and non-infected diarrheic patients in Dessie Town, Northeast Ethiopia

“…Etiologies of diarrhea could be bacterial, viral, or parasitic. People living with human immunodeficiency virus (HIV) as well as children who are malnourished or have impaired immunity are most at risk of life-threatening diarrhea [1,[6][7][8]. HIV related immunosuppression, favors the occurrence of multiple opportunistic infections (OIs) which are responsible for a high morbidity and mortality.…”

Yellow Colon: A Case of Cryptosporidium Colitis

“…1 In patients with human immunodeficiency virus with a CD4 count of less than 350 cells/mm 3 , chronic diarrhea (>1 month) caused by Cryptosporidium is an indicator of advanced disease. 2 Typical presenting symptoms include diarrhea, fever, abdominal cramping, nausea, vomiting, and weight loss, all of which were present in our patient. Stool antigen testing for Cryptosporidium is highly sensitive for detection of the protozoan and confirmation of diagnosis is achieved through tissue biopsy obtained from endoscopy.…”

Changes in peripheral blood inflammatory factors (TNF-α and IL-6) and intestinal flora in AIDS and HIV-positive individuals

“…When the intestinal flora of AIDS patients is dysfunctional, the levels of Bifidobacterium and Lactobacillus are significantly lower, and the contents of E. coli, E. faecalis and E. faecium are higher (Lei et al, 2012). Shah et al (2016) reported that E. coli is the most common bacterium associated with diarrhea in HIV patients. In addition, bacterial microbiome alteration is linked to IBD and inflammation in HIV-1 infection (Bäckhed et al, 2012;Lyte, 2013;Márquez et al, 2016).…”

“…They also have a positive effect on the immune function of HIV/AIDS patients (Irvine et al, 2010). E. coli is the most common bacterium associated with diarrhea in HIV patients (Shah et al, 2016). Moreover, bacterial microbiome alteration has been reported to be linked to inflammatory bowel disease (IBD) and inflammation in HIV-1 infection (Bäckhed et al, 2012;Lyte, 2013;Márquez et al, 2016).…”