Cyclosporiasis in hiv and non - hiv patients: A study in Kanti children's hospital and Sukra Raj tropical and infectious disease hospital, Kathmandu, Nepal.

Thesis Report.

ABSTRACT: Cyclospora cayetanensis is an emerging coccidian parasite that cause prolonged diarrhea in immunocompromised and immunocompetent hosts. The prevalence and importance of cyclospora as an enteropathogen among 86 Human Immunodeficiency Virus infected patients (16-55 years old) and 914 Non-HIV patients (15 days to 90 years) from Kanti Children's Hospital and Sukra Raj Tropical and infectious Disease Hospital was assessed during the period between May 2003 and April 2004. A total of 1000 stool samples were examined by wet mount; concentration technique; modified Ziehl-Neenlsen stain and Bisporulation method. The overall prevalence of cyclosporiasis was 10.9% in which 19.8% was in HIV patients and 10.1% was in Non-HIV patients. The lowest age of infected child in Non-HIV was of 29 days and she was female. Among 86 HIV patients, Cyclospora infected males were 17.5% and females were 26.1%, but statistically not significant (X2 =0.85, ->0.05). The prevalence was highest in 16-25 age groups (40.0%),but, statistically not significant (x2=4.17, P->0.05). The highest prevalence of males (40.0%) were in 46-55 years age groups and of females (60.0%) were in 16-25 age groups, however, statically not significant (x2 = 5.65, p_>0.05). The prevalence was highest in September 2003 (50.0%), but, statistically not significant (x2 =7.7, p_>0.05). The HIV patients, who used to drink water without any treatment, were highly infected (22.%), but, statistically not significant (x2 = 0.47, p_>0.05).Sex workers were highly infected(28.9%), but, statistically not significant (x2 = 7.1, p_> 0.05). Most of the infected stools of HIV patients were non-bloody (100%), mucus (82.3%), watery (94.1%) with frequency > 40 oocysts per coverslip (76.5%). Their major symptoms were diarrhea (100%), weight loss (100%), anorexia (88.2%), abdominal pain (82.5%), and fatigue (82.4%). Out of 17 positive samples, 41.2% showed co-infection with other intestinal parasites. The Cyclospora infection in increased frequency and severity in HIV patients shows that immune mechanisms effectively keep parasite numbers low in most normal persons. As 66.3% of infected stools showed 1-10 oocysts per coverslip in Non-HIV patients, at least, three to for the complete diagnosis of Cyclospora in immunocompetent subjects. The predominance of Cyclospora (19.8%) in HIV positive patients and children (15 days to 10 yrs.; 13.9%) and its rarity in adults (11-90 yrs.; 7.5%), in this study, suggest that Cyclospora is an important opportunistic pathogen in Kathmandu, Nepal.

Eng.