Dwivedi Kaushal Kumar, Prasad Ganga, Saini Sanjeev, Mahajan Surbhi, Lal Shiv, Baveja Usha Krishan
Centre for AIDS and Related Diseases, National Institute of Communicable Diseases, Delhi, India.
Jpn J Infect Dis. 2007 May;60(2-3):76-81.
Data on various etiologic agents causing diarrhea in human immunodeficiency virus type-1 (HIV-1) infected individuals are sparse in Delhi, India. The present study was undertaken to identify various causative agents, the role of associated risk factors and immune status. A case-control study was conducted among 75 HIV-1 infected individuals, 50 with and 25 without diarrheal infection. Fecal samples were screened for coccidian parasites, enteric protozoa, and helminthes by using various staining techniques. The CD4+ T-lymphocyte count was estimated. Enteric parasites were identified among 62.7% individuals, of which Cryptosporidium emerged as the single largest pathogen predominant among 33% of the individuals (P < 0.025). Other parasites diagnosed that were significantly associated with diarrhea were Giardia lamblia (13.3%), microsporidia (6.7%), and Isospora belli (2.7%). Chronic infected diarrheal cases were found to have polyparasitic infections. The mean CD4+ cell count was found to be lower among the diarrheal cases when compared with the non-diarrheal cases (mean, 141 cells/mm(3) versus 390 cells/mm(3)). Similarly, among diarrheal individuals, the chronic diarrheal cases had a comparatively lower CD4+ cell count than the acute cases (mean, 123 cells/mm(3) versus 265 cells/mm(3)). Risk factors found significant during multivariate analysis were: residence in a slum, exposure to pets and animals, use of public toilets, and practice of unsafe homosexual activity. Enteric coccidian parasites were identified as significant agents associated with diarrhea, especially among those with improper hygiene, multiple infections and a lower CD4+ cell count. Thus, this study emphasizes the need for routine screening of enteric parasites as well as education about practicing personal hygiene and taking timely and appropriate prophylactic measures.
在印度德里，关于导致人类免疫缺陷病毒1型（HIV-1）感染者腹泻的各种病原体的数据很稀少。本研究旨在确定各种病原体、相关危险因素的作用以及免疫状态。对75名HIV-1感染者进行了病例对照研究，其中50名有腹泻感染，25名无腹泻感染。通过各种染色技术对粪便样本进行球虫寄生虫、肠道原虫和蠕虫筛查。估算CD4 + T淋巴细胞计数。62.7%的个体中发现了肠道寄生虫，其中隐孢子虫是33%个体中最主要的单一病原体（P < 0.025）。其他被诊断出与腹泻显著相关的寄生虫有蓝氏贾第鞭毛虫（13.3%）、微孢子虫（6.7%）和贝氏等孢球虫（2.7%）。慢性感染性腹泻病例被发现有多重寄生虫感染。与无腹泻病例相比，腹泻病例的平均CD4 +细胞计数较低（平均值分别为141个细胞/mm³和390个细胞/mm³）。同样，在腹泻个体中，慢性腹泻病例的CD4 +细胞计数比急性病例低（平均值分别为123个细胞/mm³和265个细胞/mm³）。多变量分析中发现的显著危险因素有：居住在贫民窟、接触宠物和动物、使用公共厕所以及进行不安全的同性恋活动。肠道球虫寄生虫被确定为与腹泻相关的重要病原体，尤其是在那些卫生习惯不良、有多重感染且CD4 +细胞计数较低的人群中。因此，本研究强调了对肠道寄生虫进行常规筛查以及开展个人卫生教育和及时采取适当预防措施的必要性。
