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Intestinal parasitic infections in HIV-infected patients, Lao People's Democratic Republic.
PLoS One. 2014; 9(3):e91452.Plos

Abstract

BACKGROUND

HIV infection is an emerging problem in Laos. We conducted the first prospective study on intestinal parasites, including opportunistic protozoa, in newly diagnosed HIV infected patients, with or without diarrhea. The aims were to describe the spectrum of infections, to determine their prevalence and to assess their associations with diarrhea, CD4 cell count, place of residence and living conditions.

METHODOLOGY

One to three stool samples over consecutive days were obtained from 137 patients. The Kato thick smear method, formalin-ethyl concentration and specific stains for coccidia and microsporidia diagnosis were performed on 260 stool samples. Baseline characteristics regarding relevant demographics, place of residence and living conditions, clinical features including diarrhea, were collected using a standardized questionnaire.

PRINCIPAL FINDINGS

The 137 patients were young (median age: 36 years) and severely immunocompromised (83.9% at WHO stage 3 or 4, median CD4 cell count: 41/mm3). Diarrhea was present in 43.0% of patients. Parasite infection was found in 78.8% of patients, infection with at least two species in 49.6%. Prevalence rates of protozoan and helminth infections were similar (54.7% and 58.4% respectively). Blastocystis sp. was the most frequent protozoa (26.3%). Cryptosporidium sp., Cytoisospora belli and microsporidia, found at low prevalence rates (6.6%, 4.4%, 2.9%, respectively), were described for the first time in Laos. Cryptosporidium sp. was associated with persistent diarrhea. Strongyloides stercoralis was the most prevalent helminth following Opisthorchis viverrini (20.4% and 47.5% respectively). The most immunocompromised patients, as assessed by a CD4 count ≤ 50 cells/mm3, were more likely to be infected with intestinal parasites.

CONCLUSIONS/SIGNIFICANCE

HIV infection was mainly diagnosed at an advanced stage of immunosuppression in Lao patients. Intestinal parasite infections were highly prevalent regardless of their diarrheal status. Opportunistic infections were reported. Improving the laboratory diagnosis of intestinal parasite infections and the knowledge on their local risk factors is warranted.

Authors+Show Affiliations

Centre d'Infectiologie Christophe Mérieux du Laos, Ministry of Health, Vientiane, Lao People's Democratic Republic; UMI 233, Institut de Recherche pour le Développement - Université Montpellier 1, Montpellier, France.Department of Parasitology, University of Health Sciences, Vientiane, Lao People's Democratic Republic.Faculté de Médecine Lyon-Sud Charles Mérieux, Université Lyon 1, Lyon, France.Department of Infectious Diseases, Provincial Hospital, Savannakhet, Lao People's Democratic Republic.Department of Infectious Diseases, Setthatirath Hospital, Vientiane, Lao People's Democratic Republic.Service de Parasitologie, Hospices Civils de Lyon, Lyon, France.Department of Parasitology, University of Health Sciences, Vientiane, Lao People's Democratic Republic.Department of Parasitology, University of Health Sciences, Vientiane, Lao People's Democratic Republic.Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.UMI 233, Institut de Recherche pour le Développement - Université Montpellier 1, Montpellier, France.UMI 233, Institut de Recherche pour le Développement - Université Montpellier 1, Montpellier, France.Faculté de Médecine Lyon-Sud Charles Mérieux, Université Lyon 1, Lyon, France; Service de Parasitologie, Hospices Civils de Lyon, Lyon, France.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24662743

Citation

Paboriboune, Phimpha, et al. "Intestinal Parasitic Infections in HIV-infected Patients, Lao People's Democratic Republic." PloS One, vol. 9, no. 3, 2014, pp. e91452.
Paboriboune P, Phoumindr N, Borel E, et al. Intestinal parasitic infections in HIV-infected patients, Lao People's Democratic Republic. PLoS One. 2014;9(3):e91452.
Paboriboune, P., Phoumindr, N., Borel, E., Sourinphoumy, K., Phaxayaseng, S., Luangkhot, E., Sengphilom, B., Vansilalom, Y., Odermatt, P., Delaporte, E., Etard, J. F., & Rabodonirina, M. (2014). Intestinal parasitic infections in HIV-infected patients, Lao People's Democratic Republic. PloS One, 9(3), e91452. https://doi.org/10.1371/journal.pone.0091452
Paboriboune P, et al. Intestinal Parasitic Infections in HIV-infected Patients, Lao People's Democratic Republic. PLoS One. 2014;9(3):e91452. PubMed PMID: 24662743.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intestinal parasitic infections in HIV-infected patients, Lao People's Democratic Republic. AU - Paboriboune,Phimpha, AU - Phoumindr,Niranh, AU - Borel,Elisabeth, AU - Sourinphoumy,Khamphang, AU - Phaxayaseng,Saykham, AU - Luangkhot,Elodie, AU - Sengphilom,Bouachanh, AU - Vansilalom,Yathmany, AU - Odermatt,Peter, AU - Delaporte,Eric, AU - Etard,Jean-François, AU - Rabodonirina,Meja, Y1 - 2014/03/24/ PY - 2013/10/29/received PY - 2014/02/11/accepted PY - 2014/3/26/entrez PY - 2014/3/26/pubmed PY - 2015/1/16/medline SP - e91452 EP - e91452 JF - PloS one JO - PLoS One VL - 9 IS - 3 N2 - BACKGROUND: HIV infection is an emerging problem in Laos. We conducted the first prospective study on intestinal parasites, including opportunistic protozoa, in newly diagnosed HIV infected patients, with or without diarrhea. The aims were to describe the spectrum of infections, to determine their prevalence and to assess their associations with diarrhea, CD4 cell count, place of residence and living conditions. METHODOLOGY: One to three stool samples over consecutive days were obtained from 137 patients. The Kato thick smear method, formalin-ethyl concentration and specific stains for coccidia and microsporidia diagnosis were performed on 260 stool samples. Baseline characteristics regarding relevant demographics, place of residence and living conditions, clinical features including diarrhea, were collected using a standardized questionnaire. PRINCIPAL FINDINGS: The 137 patients were young (median age: 36 years) and severely immunocompromised (83.9% at WHO stage 3 or 4, median CD4 cell count: 41/mm3). Diarrhea was present in 43.0% of patients. Parasite infection was found in 78.8% of patients, infection with at least two species in 49.6%. Prevalence rates of protozoan and helminth infections were similar (54.7% and 58.4% respectively). Blastocystis sp. was the most frequent protozoa (26.3%). Cryptosporidium sp., Cytoisospora belli and microsporidia, found at low prevalence rates (6.6%, 4.4%, 2.9%, respectively), were described for the first time in Laos. Cryptosporidium sp. was associated with persistent diarrhea. Strongyloides stercoralis was the most prevalent helminth following Opisthorchis viverrini (20.4% and 47.5% respectively). The most immunocompromised patients, as assessed by a CD4 count ≤ 50 cells/mm3, were more likely to be infected with intestinal parasites. CONCLUSIONS/SIGNIFICANCE: HIV infection was mainly diagnosed at an advanced stage of immunosuppression in Lao patients. Intestinal parasite infections were highly prevalent regardless of their diarrheal status. Opportunistic infections were reported. Improving the laboratory diagnosis of intestinal parasite infections and the knowledge on their local risk factors is warranted. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/24662743/Intestinal_parasitic_infections_in_HIV_infected_patients_Lao_People's_Democratic_Republic_ L2 - https://dx.plos.org/10.1371/journal.pone.0091452 DB - PRIME DP - Unbound Medicine ER -