Spectrum of intestinal pathogens and their clinical presentation in HIV-positive patients with diarrhoea at Queen Elizabeth Central Hospital adult medical wards
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Date
2022-03-01
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Abstract
Diarrhoea is one of the most common conditions in people living with HIV (PLWHIV) in Malawi. However, there is limited data on the aetiology of diarrhoea and the specific clinical presentations in this population and setting.
The aim of this study was to identify pathogens associated with diarrhoea in PLWHIV. Specifically, the study wanted to determine the prevalence of cryptosporidiosis and other enteric pathogens and to describe their clinical presentations
This was a cross-section observational study at the Queen Elizabeth Central Hospital (QECH), a referral hospital in Blantyre, nested within a Phase 2A clinical trial of treatment of cryptosporidiosis in PLWHIV. Identification of the infectious agents in stool was done by Gastrointestinal (GI) TaqMan Array testing. We performed descriptive analyses on the prevalence of specific intestinal pathogens in PLWHIV presenting with diarrhoea comparing those with and without cryptosporidiosis. We also described the clinical presentations associated with the pathogens.
We recruited 20 adults with diarrhoea caused by cryptosporidiosis and 10 controls without diarrhoea and cryptosporidiosis. The median CD4+ T-lymphocyte count was 21 cells/microlitre for the cases and 419 cells/microlitre for the controls (p<0001). The most common pathogens isolated among the cases were enteroaggregative Escherichia coli (EAEC)-65% (95% CI 40.78 to 84.6%), enterotoxigenic Escherichia coli (ETEC) (60%), Shigella spp. (60%) and Encephalitozoon bieneusi (40%). Among the controls, the most common pathogens isolated were Blastocystis in 87.5% (95% CI 47.35% to 99.68%), Shigella spp. in 75% (95% CI 34.91% to 96.81%), enteropathogenic Escherichia coli (EPEC) in 50 % (95% CI 15.70% to 84.30%) and ETEC in 50%. There was statistically significant difference in the prevalence of Blastocystis, being more common in the controls than the cases (87.5% and 30% respectively, p=0.0107). There was no statistically significant difference in the median number of pathogens isolated from one individual between the cases and the controls, 6.5 pathogens/person among the cases and 3.5 pathogens/person among the controls (p=0.2714). The most common clinical features identified were anorexia, nausea, abdominal pain and vomiting. 95% of the cases had used antibiotics prior to admission (95% CI 50.90 to 91.34).
Our study showed that PLWHIV and diarrhoea with cryptosporidium, have low CD4 counts. They also have other enteric pathogens including EAEC, EPEC, ETEC, Shigella spp., E. bienuesi and Giardia. It also showed that Blastocystis is a common pathogen in HIV reactive patients, with and without diarrhoea. Anorexia, nausea, abdominal pain and vomiting were the common accompanying symptoms in patients with chronic diarrhoea. We also found that the use of antibiotics in chronic diarrhoea was prevalent.