Prevalence of Gastrointestinal Parasites and Urinary Tract Infections among HIV Seropositive Patients in Relation to their Immune Levels at the Bomso Specialist Hospital, Kumasi Ghana

Gastrointestinal parasitic infections (GPI) and urinary tract infections (UTI) have contributed to the progression of HIV causing significant morbidity and mortality among HIV positive patients. This study aimed at detecting the prevalence of GPI and UTI among HIV seropositive patients. A prospective cross-sectional study was conducted among 256 HIV positive patients attending the Outpatient Department of the Bomso Specialist Hospital, Kumasi, Ghana from November 2010 to April 2011. Venous blood, stool and midstream urine samples were collected from each patient. Stool samples were processed using the formol-ether concentration technique and stained by the Modified Ziehl-Neelson staining procedure. CD4 T-cell counts were measured by the FACS Count System using the FACS Flow Cytometer. Urine specimens were examined microscopically and cultured for pathogens. The overall prevalence of GPI was 18.8%. The most common intestinal parasites were Giardia lamblia 19 (39.6%) and Entamoeba histolytica 11 (22.9%). Other parasites included Ascaris lumbricoides (6.3%), Strongyloides stercoralis (4.2%), Taenia spp (4.2%), Cryptosporidium parvum (2.1%), Trichuris trichiura (2.1%), and Isospora belli (2.1%). Age and gender did not have any significant association with GPI (p>0.05) although higher prevalence was observed among females (12.9%) than male (5.9%) and age group 36-45 (6.6%). Most diarrhoea causing parasites were Giardia lamblia (100%), followed by Entamoeba histolytica (36.4%), A. lumbricoides (33.3%) and S. stercoralis (31.6%). Participants with CD4 counts <200 cells/𝜇L had higher and significant (p<0.0001) prevalence rates of parasitic infection (8.6%) than those without infection (4.3%). Mean CD4 count was lower (275.8 ± 18.0) and statistically significant (p<0.0001) among participants with intestinal parasite infections than those without the infections (485.3 ± 21.5). Urban settlement, pipe borne water usage, preparing food in open space, use of KVIP, diarrhoea and the knowledge of dewormers had a significant association with GPI (P<0.05). Most of the UTI was due to Escherichia coli (29.4%) followed by Staphylococcus aureus (20.6%) and Candida albicans (20.6%). A prevalence of 8.8% was recorded for Klebsiella pneumonia, Proteus vulgaris and Salmonella typhi isolates while Shigella spp were the least isolated pathogen (2.9%). A significant (p<0.0001) and higher proportion of females (59.8%) than males (0.8%) had bacterial infections. The age group with highest frequency was 36-45 (5.5%), the most infected group (54.5%) of UTI was observed amongst participants with CD4 counts <200 cells/𝜇L. UTI infected participants recorded a lower level of CD4 count (273.2± 20.1) than those without the infections (472.5 ± 14.4). The overall prevalence of UTI was 13.3%. The co-existence of GPI and UTI among HIV infected patients in the study area is significant. This calls for intensive public health education on improvement of environmental sanitation and good personal hygiene practices. HIV patients undergoing HAART must also be examined for GPI and UTI.

Source: KNUST