Prevalence of Cryptosporidium Parvum and Isospora Belli Infections among Children Presenting with Diarrhoea at Queen Elizabeth Central Hospital

Year 2012, Volume: 37 Issue: 3, 133 - 138, 01.09.2012

Elizabeth Kamwendo Lameck Manda Mphatso Makanda İsaac Thom Shawa Daniel Lawadi Banda G. Tom Heikens

Abstract

Purpose: Diarrhoea in children is a common problem in low resourced countries including Malawi. It is caused by many intestinal parasites including Cryptosporidium parvum and Isospora belli. Both infections are prevalent in severely immunocompromised individuals and may cause severe life-threatening diarrhoea. The main aim of the study was to assess the prevalence of Cryptosporidium parvum and Isospora belli infections among children presenting with diarrhoea admitted to QECH - paediatrics wards and methods used for diagnosis. Some specific objectives were to determine the prevalence of Cryptosporidium parvum and Isospora belli infections among human immunodeficiency virus (HIV) seropositive and HIV seronegative children with diarrhoea, to evaluate diagnostic methods used at QECH to identify intestinal parasites and to determine diagnostic methods that can be recommended for implementation. Methods: Faecal samples were collected from all children presenting with diarrhoea upon admission or already hospitalised were recruited excluding all children without or with acute diarrhoea (less than three days). Four smears were prepared from each sample: 2 for Ziehl Neelsen staining and the other 2 for Auramine-phenol staining. The data was entered into Microsoft Excel and analysed using Epi-Info. Results: A total of 25 children with diarrhoea under the age of five years; 10 were human immunodeficiency virus -seropositive, 7 were HIV-seronegative and 8 of them their status was unknown. Cryptosporidium parvum was detected in 4 children (16%) at 4.5% and 36.1% confidence intervals and none had Isospora belli at 0.0% and 86.3% confidence intervals. Out of those 4 who had Cryptosporidium parvum, 3 children were HIV-seropositive and 1 child was HIV-seronegative at a frequency of 30% and 14.3% respectively. No infection was seen in children whose HIV-serostatus was unknown. Conclusion: Modified Ziehl Neelsen technique and auramine-phenol staining can be used to examine stool at QECH for C.parvum and I.belli identification. Although I.belli is prevalent in our environment, it has not yet been detected in children and or evolved as an endemic pathogen and so far remains as an opportunistic pathogen in adults only. There is need to repeat the study in rainy season and include gold standard method.

Keywords

Cryptosporidium, Isospora, Prevalence, Malawi, Queen Elizabeth Central Hospital.

Queen Elizabeth Central Hastanesine Diyare ile Başvuran Çocuklarda Cryptosporidium Parvum and Isospora Belli Enfeksiyonları Prevalansı

Abstract

Amaç: Diyare çocuklarda Malawi"yide içeren gelir düzeyi düşük ülkelerde sık görülen problemlerden biridir. Diyare, Cryptosporidium parvum and Isospora belli gibi pek çok intestinal parazitlere bağlı olarak ortaya çıkar. Her iki enfeksiyon Her iki enfeksiyon immune direnci düşük olgularda yaşamı tehdit eden diyareye neden olabilir. Çalışmanın temel amacı QECH başvuran diyaresi olan çocuklar arasında enfeksiyonların bu enfeksiyonların sıklığını araştırmaktır Ayrıca Cryptosporidium parvum ve Isospora belliile enfekte olan insane immuneksikliği virusu (HIV) seropozitif ve HIV seronegatif diyareli çocuklarda hastalığın sıklığı yanı sıra tanı yöntemlerinin değerlendirilmesi amaçlanmıştır. Yöntem: Gaita örnekleri akut diyare (3 günden az) ve diyare olmayan cocuklar hariç kliniğimize kabul edilen ve yatmakta olan diyareli çocuklardan alınmıştır. Her bir örnekten dört yayma hazırlanmıştır: İki tanesi Ziehl,Neelsen boyaması diğer ikisi ise Auramine-Fenol boyaması ile incelenmiştir. Elde edilen veriller Microsoft Excel programına kaydedilip, Epi-Info programı kullanılarak analiz edilmiştir. Bulgular: Beş yaşın altında diyareli 25 çocuk çalışmaya dahil edildi. Bunlardan 10 tanesi HIV seropozitif, 7 tanesi HIV seronegatif 8 tanesinin ise durumu bilinmiyordu. 4 çocukta (16%) cryptosporidium parvum güven aralıkları %4.5 ve %36.1 arası ve hiçbir çocukta Isospora belli tespit edilemedi %0.0 ve %86.3 güven aralıklarında. Cryptosporidium parvum tespit edilen 4 çocuğun 3 tanesi HIV-seropozitif frekansı %30, 1 tanesi ise HIV-seronegatifti frekansı ise %14.3 idi. HIV durumu bilinmeyen çocukların hiç birinde enfeksiyon tespit edilmedi. Sonuç: Modifiye edilmiş Ziehl-Neelsen tekniği ve Auramine-Fenol boyaması QECH"e gelen gaita örneklerinin C.parvum and I.belli tespitinde kullanılabilir. Her nekadar, I.belli bizim bölgemizde yaygın olsada çocuklarda tespit edilmemiştir. Ayrıca bu organizmaların endemik patojen olarak evrimleşmedikleri ve halen yetişkinlerde fırsatçı endemik patojenler olarak hayatlarını sürdürdükleri tespit edilmiştir. Bu çalışmanın özellikle altın standart olarak kabul edilen metodlarla yağmurlu sezonda tekrarlanması gerektiği düşünülmektedir. Anahtar Kelimeler:

Keywords

Isospora, Prevalence, Malawi, Queen Elizabeth Central Hospital.

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