Cryptosporidiosis among HIV Patients Presenting with Diarrhoea Between September to December, 2012 in Specialist Hospital Sokoto, Nigeria.
SUMMARY
Diarrhoea remains one of the most important health problems globally and a leading cause of morbidity and mortality among immuno compromised individuals. It accounts for over 50 million deaths (in all ages) world-wide and it ranks 3rd among diseases responsible for human mortality globally.
This study was carried out to determine the prevalence of Cryptosporidium parvum infection among HIV patients visiting the Specialist Hospital Sokoto (SHS), Nigeria.
A total of 150 stool samples were examined for oocysts of C. parvum using the Stool concentration technique and modified Zeil-Neilson staining technique. 85 females and 65 males were tested.
The overall parasite prevalence of Human intestinal parasites encountered in the study was 22.7% (34/150) with Cryptosporidium parvum 4.0%, being the highest compared to other parasites. The age group distribution of Cryptosporidium prevalence among HIV infected patients who had diarrhoea was 4.0%.
With the highest prevalence among patients aged 46- 55years when compared to 0.0 % prevalence recorded in those aged 6 -15, 16 – 25 and 56 -60. Crypto was commoner among female patients (2.6) when compared to the male (1.4) prevalence.
There is no significant statistical difference between the two groups at 95 % Confidence. Limit. The observed monthly prevalence of Crypto among the vulnerable group was observed to be high in the month of November.
TABLE OF CONTENTS
Title page———————————————————————————————- i
Declaration——————————————————————————————- ii
Certification—————————————————————————————– iii
Dedication——————————————————————————————- iv
Acknowledgement——————————————————————————– v
Table of Contents———————————————————————————- vii
List of Tables————————————————————————————— viii
List of Appendixes——————————————————————————— ix
List of Figures————————————————————————————— x
CHAPTER ONE
1.0 Introduction——————————————————————————– 1
1.1 Background Information—————————————————————– 1
1.2 Statement of Problem——————————————————————— 2
1.3 Justification ——————————————————————————- 3
1.4 Research Question———————————————————————— 4
1.5 General and Specific Objectives——————————————————- 4
1.5.1 General Objectives———————————————————————- 4
1.5.2 Specific Objectives———————————————————————– 4
1.6 Hypothesis; Null Hypothesis———————————————————— 5
CHAPTER TWO
2.0 Literature Review———————————————————————— 6
2.1 Cryptosporidiosis————————————————————————- 6
2.1.1 Diarrhoea among HIV Positive persons——————————————— 8
2.1.2 Evaluation of Diarrhoea——————————————————————- 9
2.2 Stages of HIV infection and Opportunistic Infections opportunistic infections — 11
2.2.1: Primary HIV infection ——————————————————————— 11
2.2.2 Stage 2: Clinically asymptomatic stage ————————————————- 11
2.2.3 Stage 3: Symptomatic HIV infection —————————————————- 12
2.2.4 Stage 4: Progression from HIV to AIDS ———————————————— 13
2.3 HIV/AIDS Opportunistic Infections—————————————————- 14
2.3.1 Classifications of opportunistic infections——————————————— 14
2.3.2 Driving forces of HIV/OIs epidemic. ————————————————– 24
2.4 Public-health approach to antiretroviral treatment against HIV/opportunistic
infections in resource-limited settings————————————————— 24
2.4.1 ART regimens—————————————————————————— 26
2.4.2 Recommended first and second-line ART regimens ——————————— 27
2.4.3 Standardised regimens and simplified formularies ———————————- 28
2.5 General characteristics of Cryptosporidium——————————————- 30
2.6 Life cycle of Cryptosporidium species———————————————— 31
2.7 Pathogenesis——————————————————————————- 31
2.8 Epidemiology of Cryptosporidiosis—————————————————- 32
2.9 Transmission of Cryptospor1dium infection————————————— 33
2.10 Clinical symptoms of Cryptosporidiosis——————————————– 35
2.11 Management and treatment of opportunistic infections————————— 36
2.11.1 Management of Diarrhea in HIV Disease —————————————— 37
2.11.1.1 Weight loss—————————————————————————– 38
2.11.1.2 Evaluation of Weight Loss——————————————————— 40
2.11.1.3 Treatment of Weight Loss———————————————————— 41
2.11.2 Treatment of Cryptosporidiosis——————————————————- 42
2.12 Prevention and Control of Cryptosporidiosis————————————— 45
2.12.1 Fighting diarrhoea diseases in developing countries——————————— 47
CHAPTER THREE
3.0 Materials and Methods—————————————————————— 49
3.1 Study area——————————————————————————— 49
3.2 Study design—————————————————————————– 49
3.3 Study population————————————————————————- 50
3.3.1 Inclusion criteria————————————————————————- 50
3.3.2 Exclusion criteria———————————————————————— 51
3.4 Sample size determination/source—————————————————– 51
3.5 Sampling technique———————————————————————- 52
3.6 Study instrument————————————————————————- 52
3.6.1 Specimen collection——————————————————————— 52
3.6.2 Materials———————————————————————————- 52
3.6.3 Parasitological techniques————————————————————– 53
3.7 Data collection method—————————————————————- 54
3.8 Data management———————————————————————– 54
3.8.1 Measurement of variables————————————————————- 54
3.8.2 Statistical analysis———————————————————————– 54
3.9 Ethical considerations—————————————————————— 54
3.10 Scope and limitation of the study ——————————————- 55
CHAPTER FOUR
4.1 Results———————————————————————————— 56
CHAPTER FIVE
5.0 Discussions——————————————————————————–61
CHAPTER SIX
6.0 Conclusion——————————————————————————— 63
6. 1 Recommendations———————————————————————— 63
References——————————————————————————— 66
Appendixes —————————————————————————– 72
Ethical Approval————————————————————————- 83
INTRODUCTION
Diarrhoea remains one of the most important health problems globally and a leading cause of morbidity and mortality among immuno compromised individuals.
It accounts for over 50 million deaths (in all ages) world-wide and it ranks 3rd among diseases responsible for human mortality globally. Diarrhoea or looseness of the bowels is increased frequency, fluidity or volume of bowel movements compared to usual.
Most people have occasional attacks of acute diarrhoea, usually caused by contaminated food or water or excessive alcohol consumption. Such attacks normally clear up within a day or two, whether or not they are treated.
Chronic diarrhoea, on the other hand, may be the result of a serious intestinal disorder or of more general disease. The commonest cause of acute diarrhoea is food poisoning; the organisms involved usually being Staphylococcus, Clostridium, Salmonella, E. coli O157, Campylobacter, Cryptosporidium, and Norwalk virus.
A person may also acquire infective diarrhoea as a result of droplet infections from adenoviruses or echoviruses. The involvement of protozoan agents in humans can be traced back to the 19th Century and this group constitutes the highest group of parasites known to be associated with diarrhoeal condition. Originally the coccidian parasites are known to be pathogenic mainly to some species among the lower animals, insects, birds, and human primates.
Traditionally dirrhoeal Protozoan agents are Giardia lamblia, Entamoeba histolytica, Balantidium coli and Coccidian agents like Isospora belli, Cyclospora cayetenensis Microsporidia and, Cryptosporidium parvum. Chronic diarrhoea occurs in up to 70% of patients infected with HIV in Africa. Cryptosporidiosis, also known as crypto10, is a parasitic disease caused by Cryptosporidium, a protozoan parasite in the phylum Apicomplexa.
REFERENCES
World Health Organization Global Programme on AIDS, Guidelines for the clinical
management of HIV infection in adults(1991)..Banwat E B., Onile B A., Anyyo A,. Prevalence of Cryptosporidium infection among
under nourished children in Jos, Ccatral Nigeria. Niger Postgrad Med. J. 2003. 10: 84.Abrahamsen M.S.; Templeton T J.; Enomoto S. “Complete genome sequence of the
Apicomplexan, Cryptosporidium parvum” Science (2004) 304 – 441.Flanigan T, Whalen C, Turner J, Cryptosporidium infection and CD4 counts. Ann Intern
Med 1992; 116:840-2.Goldstein ST, Juranek D D, Ravenholt O,. Cryptosporidiosis: an outbreak associated with
drinking water despite state-of-the art water treatment. Ann Intern Med 1996;124:459-68Mönkemüller KE. Declining Prevalence of Opportunistic Gastrointestinal Disease in the
Era of Combination Antiretroviral Therapy. American Journal of Gastroenterology,
95(2):457-462Atzoni C.; Bruno A; Chichino G. HIV – 1 and parasitic infections. Tanzania. Annals of
Tropical Medicine and Parasitology (1993).Widmer G, Carraway M, Tzipori S. Waterborne Cryptosporidium: a perspective from the
USA. Parasitol Today 1996;12: 286-90Mann J M, Francis H, Quinn. Surveillance for AIDS in a Central African City,
Kinshasa, Zaire. JAMA (1986): 255: 3255 – 3259Centers for Diseases Control and Prevention “Cryptosporidiosis”
(Http://www.cdc.gov/crypto (2009) 1. Access on 30th October 2012.
StudentsandScholarship Team.
Be the first to comment