Prevalence of Protozoan in HIV/AIDS Patients with Gastrointestinal Symptoms in Zinder National Hospital, Niger Republic

doi:10.21203/rs.3.rs-5004351/v1

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Prevalence of Protozoan in HIV/AIDS Patients with Gastrointestinal Symptoms in Zinder National Hospital, Niger Republic

https://doi.org/10.21203/rs.3.rs-5004351/v1

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Background

Intestinal parasitic infections constitute one of the stubborn public health issues, particularly in low- and middle-income countries. This study aimed to investigate the prevalence and diversity of intestinal parasites among patients in a medical center in Zinder, Niger Republic.

Methods

A prospective study of 93 patients and a retrospective study of 131 patients were conducted. Stool samples were examined for the presence of parasites using standard microscopic techniques.

Results

In this prospective study, 83.7% of stool samples were tested positive for parasites, with the cystic form of Entamoeba histolytica (25.8%) and Cryptosporidium spp. (30.1%) being the most prevalent. Four patients had vegetative forms of protozoa, including two with Giardia intestinalis (2.1%) and two with E. histolytica (2.1%), and one patient was positive for Strongyloides stercoralis. In the retrospective study, 46.9% of stool samples were positive for parasites, with the E. histolytica and Pentatrichomonas hominis being the most prevalent 26.1% and 7.1%, respectively. Trophozoite of E. histolytica and G. intestinalis were present respectively in 3.2% and 2.8% of positive samples as well. Oocysts of two protozoans were identified. Cryptosporidium spp., is characterized by 28 oocysts, constituted 30.1% of the observed entities. Simultaneously, Cystoisospora belli, represented by 12 oocysts, accounted for 12.9% of the total.

Conclusion

Our findings reveal a high prevalence of intestinal protozoan parasites in HIV/AIDS patients in Niger. This points at the need for effective interventions to prevent and treat these infections. In addition, the results of this study provide important preliminary data that could inform public health policy and decision makers in the region.

HIV/AIDS

Intestinal parasites

Prevalence

Niger Republic

The West and Central Africa regions represent 12% of people living with HIV in the world[1]. Gastrointestinal parasites constitute one of the major concerns for patients living with HIV/AIDS, particularly in sub-Saharan Africa where the prevalence of these infections remains high. Infections caused by these parasites can lead to serious complications, including malabsorption, malnutrition, and dehydration[1–5]. Therefore, early diagnosis and effective treatment are critical to improving patient outcomes. The enteric parasites appear the major cause of diarrhea in HIV-infected individuals. It also highlights that low CD4 count is significantly associated with opportunistic infection[3, 6–8].

The prevalence of intestinal parasites is significantly higher in HIV-positive/AIDS patients compared to HIV-negative subjects. Intestinal parasitic infection is more common among HIV/AIDS patients, especially those with low CD4 + counts, illiteracy, and lack of access to toilets. Intestinal parasites in HIV/AIDS patients increase the risk of gastroenteritis and contribute to the complexity of the virus, particularly in Africa [1–3, 9–11].

The National Hospital of Zinder in Niger provides care for a large population of HIV/AIDS patients in the region. The literature pertaining to academically document the incidence of parasitic infections among this population reveals itself scarce, if not, sketchy. This study aimed to identify the prevalence of intestinal parasites in HIV/AIDS patients suffering from diarrhea and/or abdominal pain at the National Hospital of Zinder.

We conducted a descriptive cross-sectional study with a retrospective data collection from January 2011 to December 2021 and a prospective data collection from March 2021 to November 2021. The study population included all HIV/AIDS-positive patients who reported diarrhea and/or abdominal pain. Patients were recruited from various hospital departments, including the Department of Infectious and Tropical Diseases, Department of Internal Medicine (Men's and Women's), Gastroenterology Department, Comprehensive Care Center, and the common ward. Stool samples were collected from these patients and analyzed in their fresh state. The retrospective data collection was limited to HIV/AIDS patients who had undergone parasitological examination of their stools collected fresh state and whose data had been archived in the hospital laboratory records. To identify common protozoan and helminth parasites using the Willis and Baerman techniques[12, 13]. The modified Ziehl-Neelsen technique was used to identify opportunistic coccidian parasites[14]. The collected data were anonymized. Data analysis was performed using Epi info software version 7 (https://www.cdc.gov/epiinfo/index.html). Descriptive statistics were calculated to summarize and present data meaningfully and concisely.

In this study, we included 93 patients for the prospective part and 131 patients for the retrospective part. The mean age was 42.1 ± 11.7 years, ranging from 17 to 75 years for the prospective part, and 32.6 ± 14 years ranging from 1 to 95 years for the retrospective part. There was a predominance of female patients in the prospective part, with a sex ratio of 0.3. Overall, 83.7% of the parasitological stool exams were positive. The most commonly identified parasites among the positive samples were Entamoeba histolytica cysts (25.8%) and Cryptosporidium spp. cysts (30.1%). Additionally, four patients had vegetative forms of protozoa (two with Giardia intestinalis and two with E. histolytica), and only one patient tested positive for Anguillula spp. For the retrospective part, we included 131 patients with a mean age of 32.5 ± 14 years ranging from 1 to 95 years. A predominance of female patients was recorded. Overall, 46.9% of the stool samples tested positive. The most prevalent parasites were E. histolytica and Trichomonas intestinalis, with proportions of 26.1% and 7.1%, respectively. The vegetative forms of E. histolytica and G. intestinalis were identified in 3.2% and 2.8% of the samples, respectively (Table 1).

Moreover, oocysts of two significant organisms were identified. Cryptosporidium spp., characterized by 28 oocysts, constituted 30.1% of the observed entities. Simultaneously, Cystoisospora belli, represented by 12 oocysts, accounted for 12.9% of the total (Table 1).

Table 1

Distribution of parasites found in the stool samples of HIV/AIDS patients at the National Hospital of Zinder, Niger
	Form	Number	Proportion
I. PROSPECTIVE STUDY		N = 93
PROTOZOA
Entamoeba histolytica	Cyst	24	25.8%
Entamoeba histolytica	Trophozoite	2	2.1%
Entamoeba coli	Cyst	4	4.3%
Pentatrichomonas hominis		5	5.3%
Giardia intestinalis	Cyst	0	0%
Giardia intestinalis	Trophozoite	2	2.1%
Cryptosporidium spp.	Oocyst	28	30.1%
Cystoisospora belli	Oocyst	12	12.9%
HELMINTHS
Anguillules	Oocyst	1	1%
II. RETROSPECTIVE STUDY		N = 131
PROTOZOA
Entamoeba histolytica	Cyst	73	26.1%
Entamoeba histolytica	Trophozoite	9	3.2%
Entamoeba coli	Cyst	4	1.4%
Pentatrichomonas hominis		20	7.1%
Giardia intestinalis	Cyst	17	6.1%
Giardia intestinalis	Trophozoite	8	2.8%

This study aimed at identifying the prevalence and distribution of intestinal parasites in HIV/AIDS patients with diarrhea and/or abdominal pain in the National Hospital of Zinder, Niger. The results showed a high prevalence of intestinal parasites in these patients, with 83.7% of the stool samples from the prospective study testing positive. The most commonly identified parasites were E. histolytica and Cryptosporidium spp. The retrospective study found a lower overall prevalence of 46.9%, with the most common parasites being E. histolytica cysts and P. hominis.

These parasites cause significant morbidity and mortality in HIV/AIDS patients, especially in resource-limited settings[14]. The results of this study provide important informations for the management of HIV/AIDS patients in Niger. According Demographic, Health and Multiple Indicator Survey conducted in Niger in 2012, 0.4% of people tested aged 15–49 are infected with HIV[12]. In this population 0.2% are in the region of Zinder. A previously study conducted in 2005 by Abdoulaye Gambo, concludes that cryptosporidiosis and microsporidiosis are prevalent among HIV-infected patients with or without diarrhea in Niamey, Niger[13]. HIV/AIDS patients are at increased risk of acquiring and developing parasitic infections due to their weakened immune systems[3, 14]. The high incidence of parasitic infections in this population is a major concern, as it can further deteriorate the health of these already vulnerable patients.

The predominance of females in the prospective study is consistent with previous studies in Niger and may reflect differences in healthcare-seeking behavior or exposure to risk factors[12]. However, further investigation is needed to understand the underlying causes of this gender disparity.

The identification of E. histolytica as the most commonly identified parasite highlight the importance of targeted screening and treatment for this parasite in HIV/AIDS patients in Niger. The presence of P. hominis in the retrospective study suggests that these parasites may also be important in this patient population[13, 15–17]. P. hominis is an anaerobic flagellated protozoan that inhabits the large intestine of humans described in immunosuppressed patients. To the best of our knowledge, the present study is the first report of P. hominis in patients with in HIV/AIDS patients in Niger.

This study identify high prevalence of Cryptosporidium spp. Studies in France and Italy reported Cryptosporidium spp. as the most common protozoa found in AIDS patients with diarrhoea[15–17].

The study also found a high rate of positive stool samples for parasites in both the prospective and retrospective cohorts, with 83.7% and 46.9% of samples testing positive, respectively. This highlights the importance of routine parasitological testing in HIV/AIDS patients who present diarrhea or abdominal pain in our setting, as the identification of the specific parasite causing the symptoms can guide appropriate treatment and prevent further morbidity and mortality. Other studies demonstrated that routine examinations of stool would benefit HIV-infected and non-infected individuals by helping to reduce morbidity [4, 18].

In a related development, there are limitations to our study that should be noted. First, the study was conducted at a single hospital and may not be generalizable to other settings. Second, this study did not collect information on the CD4 cell count or antiretroviral therapy status of the patients, which may have affected the prevalence of parasites in the stool samples. Third, the use of only two diagnostic techniques (WILLIS and Baerman) for the identification of intestinal parasites [12, 13]. Other diagnostic methods, such as PCR, may have improved the detection of certain parasites and provided a better comprehensive picture of the prevalence and distribution of intestinal parasites in this patient population. Fourth, we only tested for a limited number of parasites and did not assess the prevalence of bacterial or viral causes of diarrhea in HIV/AIDS patients.

In conclusion, this study provides valuable insights into the prevalence of intestinal parasites among HIV/AIDS patients at the National Hospital of Zinder. The study highlights a high rate of positive stool examinations for protozoa, with E. histolytica and Cryptosporidium spp. being predominant in the prospective study, and E. histolytica and P. hominis in the retrospective study. Our findings emphasize the urgent need for appropriate diagnostic techniques and interventions for the detection and management of these infections in this vulnerable patient population. Furthermore, the study underscores the importance of ongoing surveillance and monitoring of the prevalence and distribution of intestinal parasites in HIV/AIDS patients, in addition to the need for further research to determine optimal treatment strategies and preventive measures to reduce the burden of these infections. These efforts could significantly improve the quality of life and clinical outcomes for HIV/AIDS patients in resource-limited settings.

Ethical approval

This study was conducted in accordance with ethical principles and received approval from the Institutional Review Board (IRB) of Faculty of Health Sciences, André Salifou University, Zinder (FSS-UASZ), Niger. The IRB reviewed the research plan, ensuring that it adhered to ethical standards and guidelines for conducting research involving human subjects. The approval from the IRB signifies compliance with the principles of confidentiality, informed consent, and the protection of participants' rights.

Availability of data and materials

Not applicable. This study does not contain any patient personal details.

Consent for publication

Not applicable.

Competing interests

Not applicable.

Funding

Not applicable.

Authors' contributions

The authors read and approved the final manuscript.

Acknowledgment

Authors acknowledge administration of the National Hospital of Zinder-Niger for the support in carrying out this study

Clinical trial number

Not applicable.

Ifeoma A, Apalata T, Aviwe B, Oladimeji O, Abaver DT. Prevalence of Intestinal Parasites in HIV/AIDS-Infected Patients Attending Clinics in Selected Areas of the Eastern Cape. Microbiol Res sept. 2022;13(3):574–83.
Alemayehu E, Gedefie A, Adamu A, Mohammed J, Kassanew B, Kebede B, et al. Intestinal Parasitic Infections among HIV-Infected Patients on Antiretroviral Therapy Attending Debretabor General Hospital, Northern Ethiopia: A Cross-Sectional Study. HIVAIDS Auckl NZ 28 oct. 2020;12:647–55.
Oguntibeju OO. Prevalence of Intestinal Parasites In HIV-Positive/AIDS Patients. Malays J Med Sci MJMS janv. 2006;13(1):68–73.
Hailemariam G, Kassu A, Abebe G, Abate E, Damte D, Mekonnen E, et al. Intestinal parasitic infections in HIV/AIDS and HIV seronegative individuals in a teaching hospital, Ethiopia. Jpn J Infect Dis avr. 2004;57(2):41–3.
Kurniawan A, Karyadi T, Dwintasari SW, Sari IP, Yunihastuti E, Djauzi S, et al. Intestinal parasitic infections in HIV/AIDS patients presenting with diarrhoea in Jakarta, Indonesia. Trans R Soc Trop Med Hyg. 2009;103(9):892–8.
Ayele AA, Tadesse D, Manilal A, Yohanes T, Seid M, Mekuria MS. Prevalence of enteric bacteria and enteroparasites in human immunodeficiency virus-infected individuals with diarrhoea attending antiretroviral treatment clinic, Arba Minch General Hospital, southern Ethiopia. New Microbes New Infect. 2020;38:100789.
Irisarri-Gutiérrez MJ, Hernández-de Mingo M, de Lucio A, Gil H, Morales L, Seguí R, et al. Association between enteric protozoan parasites and gastrointestinal illness among HIV-and tuberculosis-infected individuals in the Chowke district, southern Mozambique. Acta Trop. 2017;170:197–203.
Gupta AK, Jindal S, Adithya GK. Prevalence of opportunistic enteric parasitic infections in hiv infected individuals and their correlation with cd4 count. Apollo Med. 2018;15(3):138–41.
Akinbo FO, Okaka CE, Omoregie R. Prevalence of intestinal parasitic infections among HIV patients in Benin City, Nigeria. Libyan J Med [Internet]. 2010 [cité 16 juill 2024];5(1). Disponible sur: https://www.ajol.info/index.php/ljm/article/view/70605
Barcelos NB, Silva L, de Dias F, Menezes Filho RFG, de Rodrigues HR. Opportunistic and non-opportunistic intestinal parasites in HIV/AIDS patients in relation to their clinical and epidemiological status in a specialized medical service in Goiás, Brazil. Rev Inst Med Trop São Paulo. 2018;60:e13.
Ahmadpour E, Safarpour H, Xiao L, Zarean M, Hatam-Nahavandi K, Barac A et al. Cryptosporidiosis in HIV-positive patients and related risk factors: A systematic review and meta-analysis. Parasite [Internet]. 2020 [cité 16 juill 2024];27. Disponible sur: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191976/
Mesquita J, Esteves F, Santos C, Mega C, Coelho C, Cruz R, et al. ABC series on diagnostic parasitology part 1: the Willis method. Vet Nurse 2 sept. 2017;8(7):398–402.
Soares FA, Benitez ADN, Santos BMD, Loiola SHN, Rosa SL, Nagata WB, et al. A historical review of the techniques of recovery of parasites for their detection in human stools. Rev Soc Bras Med Trop. 2020;53:e20190535.
Quadros RMD, Marques SMT, Amendoeira CR, Souza LaD, Amendoeira PR, Comparin CC. Detection of Cryptosporidium oocysts by auramine and Ziehl Neelsen staining methods. Parasitol Latinoam déc. 2006;61(3–4):117–20.
Pavie J, Menotti J, Porcher R, Donay JL, Gallien S, Sarfati C, et al. Prevalence of opportunistic intestinal parasitic infections among HIV-infected patients with low CD4 cells counts in France in the combination antiretroviral therapy era. Int J Infect Dis IJID Off Publ Int Soc Infect Dis sept. 2012;16(9):e677–679.
Cotte L, Rabodonirina M, Piens MA, Perreard M, Mojon M, Trepo C. Prevalence of intestinal protozoans in French patients infected with HIV. J Acquir Immune Defic Syndr sept. 1993;6(9):1024–9.
Brandonisio O, Maggi P, Panaro MA, Lisi S, Andriola A, Acquafredda A, et al. Intestinal protozoa in HIV-infected patients in Apulia, South Italy. Epidemiol Infect déc. 1999;123(3):457–62.
Akinbo FO, Okaka CE, Omoregie R. Prevalence of intestinal parasitic infections among HIV patients in Benin City, Nigeria. Libyan J Med 1 janv. 2010;5(1):5506.

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Prevalence of Protozoan in HIV/AIDS Patients with Gastrointestinal Symptoms in Zinder National Hospital, Niger Republic

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Abstract

Background

Methods

Results

Conclusion

Introduction

Material & Methods

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

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