https://www.labmed.theclinics.com/article/S0272-2712(15)00029-3/pdf

Infections by Intestinal Coccidia and Giardia duodenalis.

Few data exist on the relative importance of individual Cryptosporidium species in acquired immunodeficiency syndrome cryptosporidiosis. We characterized 127 inpatients infected with human immunodeficiency virus (HIV) in Tanzania for their CD4 cell count and by stool analysis, including Cryptosporidium immunofluorescence and polymerase chain reaction-restriction fragment length polymorphism. Cryptosporidium was detected in patients both with and without diarrheal symptoms (defined as ≥ 3 liquid stools/day, 11 of 61 versus 11 of 66; P = not significant) and was a marker for low CD4 cell count (median = 124/μL versus 212/μL in Cryptosporidium-negative patients; P < 0.04). Cryptosporidium hominis was the predominant species in this region and was associated with a longer duration of symptoms, a higher rate of asymptomatic infection, and a lower CD4 cell count versus C. parvum-infected patients (P < 0.05). This study suggests there may be important differences in the natural history of Cryptosporidium infection in HIV-infected persons depending on parasite species.

Asymptomatic cryptosporidium hominis infection among human immundeficiency virus–infected patients in tanzania

The benefits of trimethoprim-sulfamethoxazole (TS) prophylaxis reported for persons living with HIV in Cote d'Ivoire are difficult to extrapolate to sub-Saharan African countries where bacterial resistance to TS is higher and cross-resistance between TS and sulfadoxine-pyrimethamine (SP) may impair SP efficacy for malaria treatment. We conducted a community-based cohort study to measure the incidence of potentially TS-preventable illnesses in Blantyre, Malawi. We found a high incidence of malaria, invasive bacterial infections, and probable bacterial pneumonias but low rates of Pneumocystis jiroveci pneumonia, isosporiasis, and Toxoplasma encephalitis. Most bacterial isolates were resistant to TS but sensitive to azithromycin, a possible alternative to TS. Clinical trials are needed to determine the role of TS or alternative regimens for prophylaxis against secondary infections among people living with HIV in sub-Saharan Africa. These should also assess benefit in patients receiving antiretroviral therapy.

A community-based study of the incidence of trimethoprim-sulfamethoxazole-preventable infections in Malawian adults living with HIV.

Cryptosporidium is one of the major causes of diarrhea in HIV-positive patients. The aim of this study is to systematically review and meta-analyze the prevalence of Cryptosporidium in these patients. PubMed, Science Direct, Google Scholar, Web of Science, Cochrane and Ovid databases were searched for relevant studies dating from the period of 1 January 2000 to 31 December 2017. Data extraction for the included studies was performed independently by two authors. The overall pooled prevalence was calculated and subgroup analysis was performed on diagnostic methods, geographical distribution and study population. Meta-regression was performed on the year of publication, proportion of patients with diarrhea, and proportion of patients with CD4  infection in HIV-positive patients was 11.2% (CI95%: 9.4%–13.0%). The pooled prevalence was estimated to be 10.0% (CI95%: 8.4%–11.8%) using staining methods, 13.5% (CI95%: 8.9%–19.8%) using molecular methods, and 26.3% (CI95%: 15.0%–42.0%) using antigen detection methods. The prevalence of Cryptosporidium in HIV patients was significantly associated with the country of study. Also, there were statistical differences between the diarrhea, CD4  is a common infection in HIV-positive patients, and safe water and hand-hygiene should be implemented to prevent cryptosporidiosis occurrence in these patients.

/pdf/cryptosporidiosis-in-hiv-positive-patients-and-related-risk-3867jsyi3s.pdf

Cryptosporidiosis in HIV-positive patients and related risk factors: A systematic review and meta-analysis.

Background Although both human immunodeficiency virus (HIV) infection and diarrhea are considerable problems in Cambodia, there have not been any studies to determine the history, clinical presentation, and etiology of chronic diarrhea in patients with HIV infection in Cambodia. In this article, we present a case-control study involving 40 HIV-infected patients with chronic diarrhea and 40 HIV-infected patients without diarrhea. Methods Clinical, demographic, and laboratory data were collected. Stool samples were examined for parasites, including Cryptosporidium species (by partial acid-fast stain), bacterial pathogens, and rotavirus. Samples from 10 case patients and 10 control subjects were also analyzed for Cryptosporidium species by polymerase chain reaction-restriction fragment-length polymorphism. Results The median CD4(+) cell count was 11.5 cells/mm(3). A potential pathogen was found in 30 case patients (75%) and 29 control subjects (72.5%). Cryptosporidium was the most common pathogen, present in 16 case patients (40%) and 20 control subjects (53.3%). The presence of Cryptosporidium was confirmed by polymerase chain reaction-restriction fragment-length polymorphism, with a prevalence of 40% in each of the 2 groups of 10 subjects who were enrolled for Cryptosporidium evaluation. Conclusions Subjects in this cohort had severe immunosuppression. The prevalence of pathogens, including Cryptosporidium, was extremely high but did not differ significantly between the case patients with diarrhea and the control subjects without diarrhea. Further studies are needed to examine factors associated with Cryptosporidium carriage and the natural history of asymptomatic infection.

Etiology of Chronic Diarrhea in Antiretroviral-Naive Patients with HIV Infection Admitted to Norodom Sihanouk Hospital, Phnom Penh, Cambodia

Objective: To assess the importance of Cryptosporidium parvum and Isospora belli infections as a cause of diarrhoea among patients admitted to the Medical Wards in Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. 
Design: Prospective case control study. 
Subjects: One hundred and twenty one patients with diarrhoea and 122 patients without diarrhoea. 
Main outcome measures: Demonstration of C. parvum and I. belli oocysts by examination of at least one stool sample per patient using phenol auramine-O-fluorescence staining and an immuno-fluorescent assay with monoclonal antibodies against Cryptosporidium, seropositivity for HIV and AIDS. 
Results: In 22% of the patients with diarrhoea an infection with C. parvum or I. belli was found. Thirteen (11%) of them had a C. parvum and 14 (12%) an I. belli infection; a mixed infection was found in one patient. In the control group, three (3%) C. parvum and three (3%) I. belli infections were seen. The prevalence of both infections was very significantly higher in the cohort of diarrhoea patients than in the controls, 13/108 versus 3/119 (p=0.0099) for C. parvum, and 14/107 versus 3/119 (p=0.0056) for I. belli. Infections were only seen in HIV positive patients. Two hundred and four (84%) patients were HIV positive and 145 (60%) of them had AIDS. 
Conclusions: C. parvum and I. belli infections are a significant cause of diarrhoea among medical in-patients at QECH. Examinations of stool specimen for parasites among hospitalised patients with diarrhoea provide data for a more appropriate management. East African Medical Journal Vol.80(8) 2003:398-401

/pdf/cryptosporidium-parvum-and-isospora-belli-infections-among-p1c3jk912z.pdf

Cryptosporidium parvum and Isospora belli infections among patients with and without diarrhoea.

IntroductionThe coronavirus pandemic overwhelmed the healthcare landscape, placing a strain on healthcare workers worldwide. In addition todirectly causing the deaths of people, the COVID-19 pandemic disrupted critical health services in developing countries. The studyaimed to explore the experiences of healthcare workers who cared for critically ill COVID-19 patients at a tertiary hospital in Malawi.MethodsA qualitative descriptive design was used. Data were gathered through in-depth interviews with doctors, clinical officers, nurses, andallied staff (n=25) who were involved in the care of critically ill COVID-19 patients at the hospital’s COVID-19 treatment centres duringthe first and second waves of the pandemic in Malawi. The interviews were conducted in English, audiotaped, and later transcribedverbatim. Conventional content analysis was used to analyse the data following the steps proposed by Hsieh and Shannon1.ResultsThe overall experience of the health workers was negative. However, delivering care to critically ill COVID-19 patients was associatedwith positive and negative experiences. The positive experience was a result of teamwork among staff and support from hospital authoritiesand the community. Negative experiences, on the other hand, were attributed to a lack of knowledge and skills in managing critically illCOVID-19 patients, a lack of resources, and abuse by some patients and members of the community. Furthermore, there was fear ofcontracting the virus from patients and fellow health workers while providing care.ConclusionThe findings point to the need for adequate preparedness within the health sector to support and protect the healthcare workers andindividuals they look after. There is a need for disease awareness strategies for health workers and the general public for future pandemics.

/pdf/healthcare-workers-experiences-in-caring-for-critically-ill-16iyllc8.pdf

Healthcare workers’ experiences in caring for critically ill COVID-19 patients at a tertiary hospital in Malawi

Objective To explore doctors’ experiences of referring and admitting patients to the intensive care unit (ICU) at two tertiary hospitals in Malawi. Design This was a qualitative study that used face-to-face interviews. The interviews were audiotaped and transcribed verbatim into English. The data were analysed manually through conventional content analysis. Setting Two public tertiary hospitals in the central and southern regions of Malawi. Interviews were conducted from January to June 2021. Participants Sixteen doctors who were involved in the referral and admission of patients to the ICU. Results Four themes were identified namely, lack of clear admission criteria, ICU admission requires a complex chain of consultations, shortage of ICU resources, and lack of an ethical and legal framework for discontinuing treatment of critically ill patients who were too sick to benefit from ICU. Conclusion Despite the acute disease burden and increased demand for ICU care, the two hospitals lack clear processes for referring and admitting patients to the ICU. Given the limited bed space in ICUs, hospitals in low-income countries, including Malawi, need to improve or develop admission criteria, severity scoring systems, ongoing professional development activities, and legislation for discontinuing intensive care treatments and end-of-life care.

/pdf/doctors-experiences-of-referring-and-admitting-patients-to-21vag5fd.pdf

Doctors’ experiences of referring and admitting patients to the intensive care unit: a qualitative study of doctors’ practices at two tertiary hospitals in Malawi

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Cryptosporidium parvum and Isospora belli infections among patients with and without diarrhoea.

Healthcare workers’ experiences in caring for critically ill COVID-19 patients at a tertiary hospital in Malawi

Doctors’ experiences of referring and admitting patients to the intensive care unit: a qualitative study of doctors’ practices at two tertiary hospitals in Malawi