Prevalence and Predisposing Factors to Intestinal Parasitic Infections in HIV/AIDS Patients in Fako Division of Cameroon

Dickson Shey Nsagha^1, , Longdoh Anna Njunda², Nguedia Jules Clement Assob², Charlotte Wenze Ayima², Elvis Asangbeng Tanue², Odette Dzemo Kibu² and Tebit Emmanuel Kwenti²

¹Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon

²Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Buea

Cite this paper:
Dickson Shey Nsagha, Longdoh Anna Njunda, Nguedia Jules Clement Assob, Charlotte Wenze Ayima, Elvis Asangbeng Tanue, Odette Dzemo Kibu and Tebit Emmanuel Kwenti. Prevalence and Predisposing Factors to Intestinal Parasitic Infections in HIV/AIDS Patients in Fako Division of Cameroon. American Journal of Epidemiology and Infectious Disease. 2017; 5(3):42-49. doi: 10.12691/ajeid-5-3-1

Abstract

Background: Understanding the epidemiology of intestinal parasitic infection is essential for the effective management of HIV infection in areas where intestinal parasites are also endemic. Data on the prevalence of intestinal parasitic infection in people living with HIV/AIDS (PLHWA) in Cameroon are sparse. This study was designed to determine the prevalence of intestinal parasitic infections, as well as assess the predisposing factors for the infection in PLHWA in Fako Division of Cameroon. Methods: This was a cross-sectional study conducted between April and July 2014. Stool specimen were collected from consented participants and examined for ova, cysts, larvae or oocytes using the Kato-Katz, Formalin-Ether Concentration, Modified Ziehl-Neelsen and Modified field staining techniques. Statistical analysis performed included the Chi-square test and logistic regression. P<0.05 was considered to be statistically significant. Results: At the end of the study, 300 participants were enrolled, the majority being females 236 (78.6%). The participants were between 21–70 years (mean±SD = 40±10) of age. The overall prevalence of intestinal parasites was 82.6% (95% CI: 78.4 – 87.0). The prevalence of infection was associated with age, being more prevalent in the age group 51–60 years (p=0.032). Intestinal protozoa were more prevalent than intestinal helminthes (74.3% vs 11.3%). The parasites isolated included: Cryptosporidium parvum (44.0%), Blastocystis hominis (25.0%), Microsporidium spp. (21.0%), Entamoeba histolytica (7.3%), Ascaris lumbricoïdes (4.3%), Isospora belli (4.3%), Trichuris trichiura (2.3%), hookworm (2.7%), Hymenolepis nana (1.3%), Strongyloïdes stercoralis (0.7%), Cyclospora cayetatensis (3.7%) and Giardia lamblia (3.3%). The predisposing factors for infection with intestinal parasites included poor educational background (OR=0.33, p=0.02), unskilled worker (OR=0.27, p=0.04), well as a source of drinking water (OR=2.6, p=0.03), and living with cats as pets (OR=3.06, p=0.01). Conclusion: A very high prevalence of intestinal parasitic infection was observed in PLHWA. Major predisposing factors for intestinal parasites infection included primary level of education, ownership of cats as pets, wells as source of drinking water and having a blue collar job. Routine screening for intestinal parasites should be instituted as part of HIV care in Fako division of Cameroon to improve on the management of HIV.

Keywords:
HIV protozoa helminthes prevalence predisposing factors Fako Division cameroon

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	UNAIDS (2012). Global Report: UNAIDS Report on the Global AIDS Epidemic 2012. Geneva, Switzerland. http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_UNAIDS_ Global_Report_2012_with_annexes_en.pdf.
[2]	Adamu H, Petros B Intestinal protozoan infections among HIV positive persons with and without Antiretroviral Treatment (ART) in selected ART centers in Adama, Afar and Dire-Dawa, Ethiopia. Ethiop. J. Health Dev. 2009; 23: 133-140.
[3]	Lehman L, Kangam L, Nguepi E, Mbenoun M, Bilong Bilong C. Study of intestinal parasitic infections associated with HIV infection in Douala, Cameroon. J Infect Dev Ctries. 2012; 7(2): 137-143.
[4]	Marius Z., Patrice E., Claire V., Carine N: Prevalence of Intestinal Parasites among HIV patients at the Yaounde Central Hospital, Cameron. The Pan African Medical Journal. 2014; 18:136.
[5]	Lekha, T., Anil, K.G., Shyam, S. and Tribhuban, M. Correlation between CD4 counts of HIV patients and enteric protozoans in different seasons- An experience of a tertiary care hospital in Varanasia (India). BMC Gastroent. 2008; 8:36-39.
[6]	Mohandas, K., Sehgal, R., Sud, A. and Malla, N. Prevalence of intestinal parasitic pathogens in HIV seropositive patients in Northern India, Jpn J Infect Dis. 2002; 55(3): 83-84.
[7]	WHO. Prevention and control of Intestinal parasitic infections. WHO Technical Report.1987; 749: 1-86.
[8]	Assefa, S., Erko, B., Medhin, G., Assefa, Z. and Shemilis, T. Intestinal parasitic infections in relation to HIV/AIDS status, diarrhoea and CD4 T-cell count. BMC Infectious Diseases 2009; 9: 155-162.
[9]	Kalinkovich A, Weisman Z, Greenberg Z, Nahmias J, Eitan S, Stein M, Bentwich Z. Decreased CD4 and increased CD8 counts with T cell activation is associated with chronic helminth infection. Clin Exp Immunol 1998; 114: 414-21.
[10]	Bentwich Z, Kalinkovich A, Weisman Z, Borkow G, Beyers N, Beyers AD. Can eradication of helminthic infections change the face of AIDS and tuberculosis? Immunol Today 1999; 20: 485-7.
[11]	Clerici M, Declich S, Rizzardini G. African enigma: key player in human immunodeficiency virus pathogenesis in developing countries? Clin Diagn Lab Immunol 2001; 8: 864-6.
[12]	Shapira-Nahor O, Kalinkovich A, Weisman Z, Greenberg Z, Nahmias J, Shapiro M, Panet A, Bentwich Z: Increased Susceptibility to HIV-1 infection of peripheral blood mononuclear cells from chronically immune activated individuals. AIDS 1998, 12: 1731-1733.
[13]	Kalinkovich A, Borkow G, Weisman Z, Tsimanis A, Stein M, Bentwich Z: Increased CCR5 and CXCR4 Expression in Ethiopians Living in Israel: Environmental and Constitutive Factors. Clin Immunol 2001, 100 (1):107-117.
[14]	Secor WE, Shah A, Mwinzi PM, Ndenga BA, Watta CO, Karanja DM: Increased density of Human Immunodeficiency Virus type 1 co-receptors CCR5 and CXCR4 on the surfaces of CD4+ T cells and monocytes of patients with Schistosoma mansoni infection. Infect Immun 2003, 71:6668-6671.
[15]	Morris A, Lundgren JD, Masur H, Walzer PD, Hanson DL, Frederick T, Huang L, Beard CB, Kaplan JE: Current epidemiology of Pneumocystis pneumonia. Emerg Infect Dis 2004, 10: 1713-1720.
[16]	Ramakrishnan K, Shenbagarathai R, Uma A, Kavitha K, Rajendran R, Thirumalaikolundusubramanian P: Prevalence of intestinal parasitic infestation in HIV/AIDS patients with diarrhea in Madurai city, south India. Jpn J Infect Dis 2007, 60: 209-210.
[17]	Nielsen NO, Friis H, Magnussen P, Krarup H, Magesa S, Simonsen P: Co-infection with subclinical HIV and Wuchereria bancrofti, and the role of malaria and hookworms, in adult Tanzanians: infection intensities, CD4/CD8 counts and cytokine responses. Trans R Soc Trop Med Hyg 2007, 101: 602-612.
[18]	Wolday D, Mayaan S, Mariam ZG, Berhe N, Seboxa T, Britton S, Galai N, Landay A, Bentwich Z. Treatment of intestinal worms is associated with decreased HIV plasma viral load. J Acquir Immune Defic Syndr 2002; 31: 56-62.
[19]	Frederico F, Haendel, Busatti G, Valeria L, Joseph F G Santos, and Maria A Gomes. High prevalence of enteroparasitosis in urban slums of Belo Horizonte-Brazil. Presence of enteroparasites as a risk factor in the family group. Pathog Glob Health. 2013; 107(6): 320-324.
[20]	Nsagha DS, Njunda AL, Assob JCN, Ayima CW, Tanue EA, kibu OD, Kwenti TE. Intestinal Parasitic Infections in relation to CD4+ T Cell Counts and Diarrhea in HIV/AIDS Patients with or without Antiretroviral Therapy in Cameroon. BMC Infectious Diseases. 2016; 16: 9.
[21]	National AIDS Control Committee (2010). The Impact of HIV and AIDS in Cameroon through 2020. http://www.healthpolicyinitiative.com/Publications/Documents/1250_1_Cameroon_EN_Singles_Reduced_acc.pdf.
[22]	Cheesbrough M. District Laboratory Practice in Tropical Countries (Second edition, Part 1), Cambridge. 2006; 178-235.
[23]	Cheesbrough, M. District Laboratory Practice in Tropical Countries. 2005, 3Rd ed., part 1, pp. 178-215. Cambridge University Press, United Kingdom.
[24]	Henriksen S, Pohlenz J. Staining of Cryptosporidia by a modified Ziehl-Neelsen technique. Acta Vet Scand. 1981; 22: 594-596.
[25]	Sarfati, C., Bourgeois, A., Menotti, J., Liegeois, F., Moyou-Somo, R., Delaporte, E., Dero uin, F., Ngole, M. and Molina, J. Prevalence of intestinal parasites including Microsporidia in Human Immunodeficiency virus-infected adults in Cameroon: A cross-sectional study. Am. J.Trop. Med. Hyg; 2006; 74(1): 162-164.
[26]	Brandonisio O, Maggi MA, Lisi A, Anriola A, Acquafredda A, Angarano G. Intestinal protozoa in HIV-infected patients in Apulia, South Italy. Epidemiol Infect. 1999; 123: 457.
[27]	Udeh EO, Goselle ON, D-Popova DD, Abelau M, Popov TV, Jean N., David J. S. The prevalence of intestinal protozoans in HIV/AIDS patients in Abuja, Nigeria. Sci World J. 2008; 3: 14.
[28]	Gomez, M., Atzoric, L., Rossi, P., Scalgia, M. and Pozio, E. Opportunistic and non-opportunistic parasites among HIV positive and negative patients with diarrhoea in Tanzania. Trop Med.1996; 46(2), 109-114.
[29]	Moura H, Fernandes O, Viola JPB, Silva SP, Passes RH, Lima DB. Enteric parasites and HIV infection: occurrence in AIDS patients in Rio de Janeiro, Brazil. Mem Inst Oswaldo Cruz.1989; 84: 527.
[30]	Wiwanitkit V. Intestinal parasitic infections in Thai HIV-infected patients with different immunity. BMC Gastroenterol. 2001; 1: 1.
[31]	Babatunde SK, Salami AK, Fabiyi J P, Agbede OO, Desalu OO. Prevalence of intestinal parasitic infestation in HIV seropositive and seronegative patients in Ilorin, Nigeria. Ann Afr Med 2010; 9: 123-8.
[32]	Cornelius KK., Robert S., Rose., Prevalence of Intestinal parasitic infections among HIV patients in Baringo, Kenya. Pan Afr Med J.2012; 13: 37.
[33]	Njunda A.L., Assob N.J.C., Nsagha S.D., Nde F.P., Kamga F.H.L., Asangbeng T.E., and Kwenti E.T. (2012). Low Prevalence of Helminth infection among HIV patients in Cameroon. Research and Reviews: Journal of Microbiology and Biotechnology; 1(1): 611.
[34]	Ostan D, Kilimciogu A, Girginkardesler N, Oeyurt B, Limoncu E, and Okru.2007.Health Iniquities : Lower Socio-economic Conditions and higher Incidences of Intestinal Parasites. BMC Public Health 7:342.
[35]	Zelalem MT, Abebe G, Mulu A. Opportunistic and other intestinal parasitic infections in AIDS patients, HIV sero-positive healthy carriers and HIV sero-negative individuals in Southwest, Ethiopia. East Afr J Public Health. 2008; 5: 169-73.
[36]	Koch KL, Shankey TV, Weinstein GS, Dye RE, Abt AB, Current WL, et al. Cryptosporidiosis in a patient with hemophilia, common variable hypogammaglobulinemia, and the acquired immunodeficiency syndrome. Ann Intern Med 1983; 99: 337-40.
[37]	Egger M, Nguyen XM, Schaad UB, Krech T. Intestinal cryptosporidiosis acquired from a cat. Infection 1990; 18: 177-8.
[38]	Xiao L, Cama VA, Cabrera L, Ortega Y, Pearson J, Gilman RH. Possible transmission of Cryptosporidium canis among children and a dog in a household. J Clin Microbiol 2007; 45: 2014-16.
[39]	Jessica B, Linda T, Rickard E, Karin T, Jadwiga WK and Marianne L. Possible zoonotic transmission of Cryptosporidium felis in a household. Infection Ecology and Epidemiology. 2015, 5: 28463.
[40]	Adesiji YO, Lawal RO, Taiwo SS, Fayemiwo SA, Adeyeba OA. Cryptosporidiosis in HIV infected patients with diarrhea in Osun State, Southwestern Nigeria. Eur J Gen Med. 2007; 4:119-22.
[41]	Faye B, Tine RC, Ndiaye JL, Kintega c, Mange NM, Snowps and Gaye S. Impact of Intestinal Parasites on Intensity of HIV infections in Senegal. Journal of Antiviral and Antiretroviral therapy 2010; 1: 011-012.
[42]	Ortega, Y.R., Sterling, C.R. and Gilman, R.H. Cyclospora cayetanenesis. Advances in Parasitology.1998; 40: 399-418. S24-S27.
[43]	Al-Delaimy AK, Al-Mekhlafi HM, Nasr NA, Sady H, Atroosh WM, et al. Epidemiology of Intestinal Polyparasitism among Orang Asli School Children in Rural Malaysia. PLoS Negl Trop Dis. 2014; 8(8): e3074.