Etiology of Chronic Diarrhea in Antiretroviral‐Naive Patients with HIV Infection Admitted to Norodom Sihanouk Hospital, Phnom Penh, Cambodia

Senya, Chhin; Harwell, Joseph I.; Bell, Joanna D.; Rozycki, G; Ellman, Tom; Barnett, Janine; Ward, Honorine; Reinert, Steven E.; Pugatch, David

doi:10.1086/507531

Cited by 34 publications

(28 citation statements)

References 30 publications

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“…Such findings in HIV-infected patients were not reported from neighboring countries in Southeast Asia [22], [23], [24], [25], [26], [27], [28], [29]. Comparing prevalence rates of parasitic infections in HIV-infected patients amongst different countries or regions requires caution.…”

Section: Discussionmentioning

confidence: 88%

“…The prevalence rates of cryptosporidiosis and microsporidiosis in HIV-infected population varied widely in previous studies from industrialized and developing countries, including neighboring countries of Laos. Prevalence of cryptosporidiosis varied from 0 to 100% with a median of 32%, and that of microsporidiosis from 5 to 50% with an overall prevalence of 15% [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38]. The presence or absence of diarrhea was not always specified in these studies.…”

Section: Discussionmentioning

confidence: 99%

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Intestinal Parasitic Infections in HIV-Infected Patients, Lao People’s Democratic Republic

et al. 2014

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BackgroundHIV infection is an emerging problem in Laos. We conducted the first prospective study on intestinal parasites, including opportunistic protozoa, in newly diagnosed HIV infected patients, with or without diarrhea. The aims were to describe the spectrum of infections, to determine their prevalence and to assess their associations with diarrhea, CD4 cell count, place of residence and living conditions.MethodologyOne to three stool samples over consecutive days were obtained from 137 patients. The Kato thick smear method, formalin-ethyl concentration and specific stains for coccidia and microsporidia diagnosis were performed on 260 stool samples. Baseline characteristics regarding relevant demographics, place of residence and living conditions, clinical features including diarrhea, were collected using a standardized questionnaire.Principal FindingsThe 137 patients were young (median age: 36 years) and severely immunocompromised (83.9% at WHO stage 3 or 4, median CD4 cell count: 41/mm3). Diarrhea was present in 43.0% of patients. Parasite infection was found in 78.8% of patients, infection with at least two species in 49.6%. Prevalence rates of protozoan and helminth infections were similar (54.7% and 58.4% respectively). Blastocystis sp. was the most frequent protozoa (26.3%). Cryptosporidium sp., Cytoisospora belli and microsporidia, found at low prevalence rates (6.6%, 4.4%, 2.9%, respectively), were described for the first time in Laos. Cryptosporidium sp. was associated with persistent diarrhea. Strongyloides stercoralis was the most prevalent helminth following Opisthorchis viverrini (20.4% and 47.5% respectively). The most immunocompromised patients, as assessed by a CD4 count ≤ 50 cells/mm3, were more likely to be infected with intestinal parasites.Conclusions/SignificanceHIV infection was mainly diagnosed at an advanced stage of immunosuppression in Lao patients. Intestinal parasite infections were highly prevalent regardless of their diarrheal status. Opportunistic infections were reported. Improving the laboratory diagnosis of intestinal parasite infections and the knowledge on their local risk factors is warranted.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Intestinal Parasitic Infections in HIV-Infected Patients, Lao People’s Democratic Republic

et al. 2014

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“…While immuno-compromised persons are more susceptible to diarrhoeal illness, the pathogens are similar to those in immunocompetent persons, with differences mainly seen with opportunistic parasitic infections. 87,103,104 Where higher rates are seen in immuno-compromised patients this may be due to the higher likelihood of seeking medical attention for their symptoms, and are more likely to be tested for pathogens. 105 …”

Section: Discussionmentioning

confidence: 99%

Prevalence of gastrointestinal pathogens in Sub-Saharan Africa: systematic review and meta-analysis

Fletcher-Lartey

Stark

Ellis

2011

J Public Health Africa

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A significant proportion of vulnerable people in sub-Saharan Africa (SSA) remain at risk for contracting diarrhoeal diseases due to the presence of many risk factors facilitating their transmission. A systematic review of published articles from the SSA region was done to determine the prevalence and types of diarrhoeal pathogens in circulation, based on a search of databases, including EBSCO host, PubMed, Scopus, Science Direct, Google scholar and Web of Science was done between September 2009 and December 2010. Data were summarized from 27 studies, with pooled data analysed and reported. Pathogens were isolated from between 26.8–65.6% of cases, with an overall isolation rate of 55.7% (95% CI, 48.2–62.9%). Isolation rates were highest amongst adult cases followed by children, and the odds of isolating a pathogen was greater in diarrhoeal cases (Odds Ratio 4.93 (95% CI, 1.99 to 12.23), than in asymptomatic controls. Overall isolation ranged from 8% to 99%; and heterogeneity testing suggests differences between age groups (Q=5.806; df=2, P=0. 055). Mixed E. coli spp., (29.95%), Cryptosporidium (21.52%), Cyclospora (18%), Entamoeba. (13.8%), Shigella spp. (10.49%), Salmonella spp. (8.36%), and Campylobacter spp. (8.33%), were most commonly reported, and rotavirus was the most common virus isolated. This is the first review to look at the range of enteric pathogens circulating in SSA, and has confirmed high rates of isolation of pathogens from diarrhoeal cases. Public health practitioners can use this information to understanding the challenges related to diarrhoeal illness and set priorities for their prevention and control.

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“…The prevalence of cryptosporidiosis varied according to geographical locations. In Southeast Asia, the infective rate of C. parvum is up to 40 per cent12. In clinical cryptosporidiosis, chronic diarrhoea with watery stools, weight loss and dehydration are the prominent features in symptomatic patients13.…”

Section: Intestinal Protozoan Parasitesmentioning

confidence: 99%

Parasitic infections in HIV infected individuals: Diagnostic & therapeutic challenges

Nissapatorn¹,

Sawangjaroen²

2011

Indian J Med Res

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After 30 years of the human immunodeficiency virus (HIV) epidemic, parasites have been one of the most common opportunistic infections (OIs) and one of the most frequent causes of morbidity and mortality associated with HIV-infected patients. Due to severe immunosuppression, enteric parasitic pathogens in general are emerging and are OIs capable of causing diarrhoeal disease associated with HIV. Of these, Cryptosporidium parvum and Isospora belli are the two most common intestinal protozoan parasites and pose a public health problem in acquired immunodeficiency syndrome (AIDS) patients. These are the only two enteric protozoan parasites that remain in the case definition of AIDS till today. Leismaniasis, strongyloidiasis and toxoplasmosis are the three main opportunistic causes of systemic involvements reported in HIV-infected patients. Of these, toxoplasmosis is the most important parasitic infection associated with the central nervous system. Due to its complexity in nature, toxoplasmosis is the only parasitic disease capable of not only causing focal but also disseminated forms and it has been included in AIDS-defining illnesses (ADI) ever since. With the introduction of highly active anti-retroviral therapy (HAART), cryptosporidiosis, leishmaniasis, schistosomiasis, strongyloidiasis, and toxoplasmosis are among parasitic diseases reported in association with immune reconstitution inflammatory syndrome (IRIS). This review addresses various aspects of parasitic infections in term of clinical, diagnostic and therapeutic challenges associated with HIV-infection.

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Etiology of Chronic Diarrhea in Antiretroviral‐Naive Patients with HIV Infection Admitted to Norodom Sihanouk Hospital, Phnom Penh, Cambodia

Cited by 34 publications

References 30 publications

Intestinal Parasitic Infections in HIV-Infected Patients, Lao People’s Democratic Republic

Intestinal Parasitic Infections in HIV-Infected Patients, Lao People’s Democratic Republic

Prevalence of gastrointestinal pathogens in Sub-Saharan Africa: systematic review and meta-analysis

Parasitic infections in HIV infected individuals: Diagnostic & therapeutic challenges

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