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Annals of African Medicine
Annals of African Medicine Society
ISSN: 1596-3519
Vol. 3, Num. 2, 2004, pp. 80-82
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Annals of African Medicine, Vol. 3, No. 2, 2004, pp. 80-82
CRYPTOSPORIDIUM INFECTION IN UNDERNOURISHED
CHILDREN WITH HIV/AIDS IN
JOS, NIGERIA
E. B. Banwat, D.Z. Egah, E. S. Audu, *B. A. Onile and ** P. R. Datong
Department of Medical Microbiology, Jos University Teaching
Hospital, Jos, *Department of Medical Microbiology and Parasitology, University
of Ilorin Teaching Hospital, Ilorin And **Department of
Paediatrics, Plateau Specialist Hospital, Jos, Nigeria
Reprint requests to: Dr.
E.B. Banwat, Department of Medical Microbiology, Jos University Teaching Hospital,
P. M. B. 2076, Jos, Plateau
State, Nigeria
Code Number: am04021
ABSTRACT
Background: AIDS and Protein energy
malnutrition (PEM) severely impair the immune system Cryptosporidium has
over the last two decades emerged as a life threatening disease. The study
attempts to determine the prevalence of Cryptosporidium infection in
malnourished children with HIV/AIDS.
Method: Blood and stool samples of 52
HIV-seropositive children and another 52 HIV-sero-negative children aged 0-5
years were collected and screened for HIV and Cryptosporidium oocysts
respectively. The sera were screened by double ELISA and the stool by the
modified Ziehl-Neelsen method.
Results: Out of the 52 HIV-seropositive
undernourished, under-five children, none (0%) excreted Cryptosporidium
oocyst in their stools while 2 (3.8%) of the control group excreted the oocyst.
Conclusion: Cryptosporidium infection
seems to be uncommon among undernourished under five children with HIV/AIDS in
Jos.
Key words: Cryptosporidium, children, HIV/AIDS,
undernutrition
INTRODUCTION
Protein energy malnutrition (PEM)
and acquired immunodeficiency syndrome (AIDS) are important causes of acquired
immune incompetence in African Children. 1,2 Cryptosporidium,
a common enteric protozoan has since 1907 been known to parasitize a wide range
of animals. 3, 4 It has been widely reported as ubiquitous and
significant enteropathogen of immuno-compromised patients. 4 Since
1983 cryptosporidiosis has emerged, along with AIDS, as a life threatening
disease. 5 The synergistic impairment of the immune system when
AIDS and PEM operate in concert is well known. 6, 7
Cryptosporidium has a higher prevalence in young children. 8
These, coupled with the fact that, no such work has been done in our
environment (to our knowledge), prompted us to look at the situation in
undernourished children less than five years with HIV/AIDS in Jos.
MATERIALS AND METHODS
Study area and
population
This prospective study was
hospital based. It involved 52 consecutive HIV sero-positive undernourished
children aged 0-5 years. Another 52 consecutive HIV sero-negative
undernourished children aged 0-5 years served as control. The study population
was attending the paediatric services of the Jos University Teaching Hospital,
Plateau Specialist Hospital and Our Lady of Apostle (OLA) Hospital. All located
in Jos metropolis. The study was over a period of 9 months.
The Wellcome
party classification 9 was used to classify the malnutrition.
Consent was obtained before recruitment into the study. Ethical clearance was
given by the JUTH ethical committee. The details of personal and clinical
information were obtained using a questionnaire.
Sample collection
Serum:
Blood samples were collected aseptically by venipuncture of the cubital or
femoral veins as the case may be. The area was cleaned using 70% isopropyl
alcohol in water with 1% iodine for at least 1 minute and allowed to dry. With
precautions to avoid touching and re-contamination, the needle was inserted and
4-5 mls of blood was obtained. This was then dispensed into clean plastic
containers (Z-10 tubes). The blood was allowed to clot and serum separated by
centrifuging at 1,800 rpm. The serum thus obtained was used for HIV serology by
the ELISA method using genelavia kits. Absorbance was read with ELX80
micro-plate Reader (Bio-Tek instrument INC.USA). Another separate sample was
obtained from seropositive patients and a re-run for HIV antibodies (double
ELISA) was carried out. Ninety-Five percent (95%) sensitivity of the ELISA
method had been documented from our center. 10
Stool:
Whenever possible, stools were collectedinto clean, wide mouthed,
grease-free, screw capped and numbered glass containers, provided for each
child. These were returned to the laboratory immediately. The stool samples
were processed each day within 4hours of collection. Appearance and consistency
were noted for each stool sample. The demonstration of Cryptosporidium oocyst
was by microscopical examination of smears made after formol-ether
concentration of stools and stained by the modified Ziehl-Neelsen (Z-N)
technique as given by the WHO 11 and examined with the oil immersion
objective of a light microscope. Cryptosporidium positive slides, which served
as control, were obtained from Veterinary public Health department Ahmadu Bello
University Zaria.
RESULTS
The age and sex distribution of
the 52 HIV sero-positive under-nourished, under five children shows that 61.5%
were males and 38.5% were females (ratio M: F=1.6:1) mostly aged 0 to 20 months
(Table 1.)
None of the 52
HIV sero-positive undernourished, under-five children excreted Cryptosporidium
oocyst in their stools. Out of the 52 HIV sero-negative group 2 (3.8%) excreted
Cryptosporidium oocyst in their stool. (Table 2). Both were females aged
12 and 17 months.
Table 1: Age and sex of undernourished, under-five children
with HIV/AIDS in Jos
Age (months)
|
Sex
|
|
Total
|
|
M
|
F
|
|
0 10
|
12
|
8
|
20
|
11 20
|
16
|
8
|
24
|
21 30
|
4
|
0
|
4
|
31 40
|
0
|
4
|
4
|
41+
|
0
|
0
|
0
|
Total (%)
|
32 (61.5)
|
20 (38.5)
|
52 (100)
|
Table 2: HIV status and Cryptosporidium infection in
undernourished under-five children in Jos
HIV status
|
Cryptosporidium oocyst in stool
|
|
Total
|
|
Positive (%)
|
Negative (%)
|
|
Negative
|
2 (3.8)
|
50 (96.2)
|
52
|
Positive
|
-
|
52 (100)
|
52
|
DISCUSSION
Cryptosporidium is present
in 1-3 % of immunocompetent patients with diarrhoea in industrialized countries
and 7-10% in developing Countries. 5,12-14 The prevalence is much
higher in patients with HIV infection. In USA, Europe and Asia, 8-30% excreted Cryptosporidium
oocysts in various series. 13,15,16 This figure is 15-50% in
developing countries, 17,18 making it one of the most common
entero-pathogens.
The overall
prevalence in this study is low (0% in HIV/AIDS patients and 3.8% in the
control group) and contrasts with the above findings and other reports from
Nigeria19, 20. Although a similarly low prevalence had been reported
in immunocompetent patients in Nigeria21 and elsewhere22.
The variation of this finding with reports from the Industrialized countries
could be due to; differences in the study population and their use of more
sensitive diagnostic techniques e.g. Polymerase chain reaction, Fluorescent
assay using monoclonal antibody etc. Also only single stool specimens were
examined in this study and only 30% sensitivity of single stool specimen has
been reported. 23
Geographical,
social and ethnic differences could explain the variation of our findings with
reports from Nigeria and other developing countries. For instance children
recruited into this study were on absolute breast feeding, as all the Hospitals
are baby friendly Hospitals. Wolfson22 recorded no case of
cryptosporidiosis in infants and attributed it to the protective role of
breast-milk. Moreover, this study was hospital based as opposed to other reports
in Nigeria19, which were community based, where the intimacy with
animals is common.
Although an
incidental finding is not impossible, the low prevalence concurs with the
declining number of cryptosporidiosis among HIV patients largely because of
immune reconstitution with highly active anti-retroviral therapy. 24
In this report, Cryptosporidium
infection seems to be uncommon among undernourished under five children with
HIV/AIDS
in Jos.
ACKNOWLEDGEMENT
We are thankful to the management
and staff of the medical microbiology departments of the Jos University
Teaching Hospital, Plateau Specialist Hospital and Our Lady of Apostle
Hospital, Jos
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