Intestinal parasitic infections and eosinophilia in an human immunedeficiency virus positive population in Honduras. The occurrence of intestinal parasites, their regional distribution and their relations to eosinophilia were studied in human immunodeficiency virus HIV positive individuals from Honduras. After signing an informed consent, participants answered a socio-demographic and risk factor questionnaire, a complete physical examination, medical history, and a series of laboratory tests. All participants were HIV positive but not acquired immunodeficiency syndrome positive. Overall occurrence of nematodes was:
|Published (Last):||12 April 2006|
|PDF File Size:||8.95 Mb|
|ePub File Size:||16.95 Mb|
|Price:||Free* [*Free Regsitration Required]|
Intestinal parasitic infections and eosinophilia in an human immunedeficiency virus positive population in Honduras. The occurrence of intestinal parasites, their regional distribution and their relations to eosinophilia were studied in human immunodeficiency virus HIV positive individuals from Honduras.
After signing an informed consent, participants answered a socio-demographic and risk factor questionnaire, a complete physical examination, medical history, and a series of laboratory tests. All participants were HIV positive but not acquired immunodeficiency syndrome positive.
Overall occurrence of nematodes was: No cases of Giardia lamblia , acute amebiasis or cryptosporidiasis were diagnosed. Helminths and non pathogenic protozoa, as single or mixed infections, occurred among the participants. There was a strong correlation between eosinophilia and helminthiasis infections; however, none was identified between CD4 levels and eosinophilia. Because parasitic infections aggravate malnutrition and promote a disbalanced Th2 response in a potentially immuno-compromised host, their effect on HIV disease progression needs further study, mainly in countries were HIV and parasitic infections are highly prevalent.
Key words: eosinophilia - helminth infection - human immunodeficiency virus - intestinal parasites - Honduras. In times when the human immunodeficiency virus HIV has caused the largest and the most devastating pandemic in the history of humankind, parasitic infections still remain one of the most prevalent types of infection in the world Savioli et al.
Many of the populations at high risk for HIV also live in highly endemic areas of intestinal parasitic infections, which are mainly acquired in childhood and remain as chronic infections into adulthood Bundy et al.
There is mounting evidence that these helminthic infections influence the HIV disease progression by regulating the host immune response, both at the cellular and humoral level, as the result of a strong T helper 2-type cytokine profile Kalinkowich et al. Both helminthic and protozoan infections are highly prevalent in the country, and parasites such as Strongyloides stercoralis, Ascaris lumbricoides, Trichuris trichiura, and Hookworms, known to be strongly associated with a Th2 cytokine shift accompanied by eosinophilia, could represent a condition associated with rapid immunocompetence deterioration, as observed empirically in Honduras in those HIV infected individuals.
This study shows for the first time in Honduras the epidemiological evidence of a high degree of co-infection with parasitic intestinal helminths associated to eosinophilia and HIV. The presence of individuals infected with intestinal parasites in situations of poverty, with deficient sanitary infrastructure, lack of latrines or poor use of them, overcrowding, and soil characteristics favorable for the proliferation of parasites provide conditions for the maintenance and transmission of such infections Beaver et al.
According to WHO estimates, at least 2 billion people in the world suffer from helminthiasis, and, of those, approximately million suffer associated severe morbidity Savioli et al. The morbidity associated with such infections includes a wide range of abdominal complications, including malnutrition, chronic anemia, and dysenteric syndrome, all of which affect growth, development, and cognitive capacity in children, as well as work productivity in adults Beaver et al.
In many cases, the magnitude of these distortions has been found to be largely proportional to the worm burden Beaver et al. On the other hand the influence of HIV-1 infection characterized by a Th1 type immune response may decrease interleukine-5 and IgE responses in patients with strongyloidiasis, which usually produces asymptomatic or mild infections, and develop into severe disseminated strongyloidiasis Porto et al.
Recent estimates indicate an adult 15 to 49 years old HIV prevalence of 1. Most HIV therapy was at the experimental stage and mostly unavailable for developing countries in , at the time this research was conducted Wheeler et al. Consequently, opportunistic infections appear early and are frequent when patients develop AIDS. In countries where both parasitic and HIV infections are highly prevalent, such as in Honduras, the prevention and management of these diseases and their complications are critical.
The present study describes the prevalence of intestinal parasitic infections in Honduras in an HIV infected population in five large cities in Honduras, and the associations with eosinophilia, which is considered a marker of a Th2 response. Between March and November , a total of HIV seropositive individuals from all those attending public clinics that belong to the Ministry of Health were deliberatedly recruited for a study by the University of Miami investigating HIV subtypes and human herpesvirus 8 infections Sosa et al.
Participants represented a cross-sectional sampling of the population and were recruited, when eligible, as they visited the clinic during their routine medical check up.
They were enrolled consecutively after signing an informed consent form. Of the participants, Participants with AIDS, intravenous drug users, and hemophiliacs were excluded. The study individuals were recruited from 5 major cities: Tegucigalpa the capital city , Comayagua, a city in the Central region, San Pedro Sula the second largest city, at the North coast , and La Ceiba and Tela, also in the Northern region. A socio-demographic and risk factor questionnaire, a complete physical examination, a focused medical history, and a series of laboratory tests performed in a certified United States laboratory included a complete hemogram, CD4 cell counts, genital specimen cultures, serology tests, HIV-1 ELISA and Western Blot tests.
A single stool sample was obtained from each individual for parasitologic diagnosis, collected fresh in a clean plastic vial properly identified and received for processing in Tegucigalpa at the Hospital-Escuela Parasitology Laboratory in the same day.
Care was exerted to distinguish the most outstanding features of the five common species of ameba in man E. Diagnosis was achieved after studying many cyst forms. Zoonotic species or the flagellate Dientamoeba fragilis with no cyst stage, however, may have gone unrecognized. Identification and quality control for intestinal apicomplexa was provided by including positive samples at the time of staining as well as by oocyst morphology and size. Descriptive and univariate analyses were performed using Epi Info 6, version 6.
Complete data from the participants have been already published elsewhere Sosa et al. For purposes of our study, we present data on the participants. The majority were from a low socio-economic status. The mean age was The mean education was 5. It was mentioned that during the enrolment those individuals with AIDS were excluded since the purpose of the Miami University study was to evaluate HIV positive but asymptomatic persons with an intact immune system. None of the participants were receiving antiretroviral therapy.
Among subjects who provided blood samples the following laboratory results were obtained: the median hemoglobin was The median leukocyte count was 6. The median eosinophil count was 8. Of the Retrospective analysis of sera looking for predominant cytokine patterns was not feasible. No reference to acute or chronic diarrhea was made at the time of stool delivery by the participant, therefore we do not know what determined the consistency of the sample.
Of the 15 diarrheic samples, 8 were negative for parasites and, in the remaining 7 very light infections of A. Ten percent 13 individuals had Charcot-Leyden crystals in stools, alone 5 samples or together with soil transmitted helminths STH. Nine of the 13 cases were from San Pedro Sula.
Incidental E. The specific parasite frequencies by cities of origin are shown in Table I. Sixty-seven percent of participants were infected with several species of pathogen and non-pathogen parasites. No cases of G. Frequencies were higher for Trichuris and Hookworm infections in San Pedro Sula, Tela, and La Ceiba, which are coastal areas, than in Tegucigalpa and Comayagua, which are located in the Central region, although no statistical differences were observed.
Of the 5 Ascaris and 5 Trichuris infections with high egg count per gram of stool epg range One participant was simultaneously infected with A. The mean eosinophil percent for participants who were co-infected with soil-transmitted helminths was consistently and significantly higher than in those who were not infected with these types of parasites.
Table III shows the prevalence of non pathogen protozoa. In epidemiologic studies aiming at detecting asymptomatic parasitic infections, some considerations include: species of parasites searched for, methods best suited and participant compliance. Also, no one method is suited for diagnosis of all species of parasites; by processing and examining the samples by five different methods we expected to obtain acceptable, reliable results.
The results of this study indicate that the mean eosinophil percents for participants who were co-infected with soil-transmitted helminths was consistently and significantly higher than in those who were not infected with these types of parasites.
These results are consistent with studies that show that infection with intestinal helminths results in immune responses involving cytokines produced by T-helper cell type 2, with IgE production, eosinophilia and mastocytosis Bentwich et al. In situations of chronic helminthic infections the Th2 subset dominates and is thought to depress Th-1 functions, facilitating HIV disease progression Actor et al.
Th2 response has been associated with wasting and more rapid HIV disease progression, confirming previous research that showed that eosinophil percentages were directly and significantly correlated with viral load and inversely correlated with CD4 cell count Actor et al.
As this study had been designed with other objectives in mind no follow up was considered; furthermore, the above mentioned correlations could neither be demonstrated or was it possible in retrospect to check for predominant cytokine patterns in the frozen sera. Observations in a recent study of Ethiopian Jews who recently migrated to Israel showing improvement and recovery of immune functions following de-worming, would be somewhat more difficult to prove in our case given that individuals continue living in contaminated environments Bentwich et al.
The results of the parasitology exams reveal no specific trend in intestinal parasite occurrence in this group of HIV positive individuals and did not differ significantly from those found in other Honduran population groups Kaminsky Most likely, the presence of infected individuals is clearly related to poor sanitation, use of contaminated water, utilization of common soil defecating areas, together with appropriate conditions of soil, temperature and humidity such as those prevailing at most locations in Honduras, which are ideal situations for the permanence of soil transmitted helminths Beaver et al.
Not finding C. Our results showed a high prevalence and a great variety of helminths as single or mixed infections. They suggest high human fecal contamination and frequent exposures. Because primary parasitic infections are generally associated with low mortality rate, control programs are usually given low priority. The newly emerging relationship of helminthic infections to HIV, however, and its potential impact on HIV progression, especially in countries where co-infection with HIV is a growing reality justify efforts for strengthening such programs, and increasing measures to prevent and remedy conditions that foster transmission of parasitic infections.
On the other hand, and from a practical point of view, it is interesting to realize that in the absence of a copro-parasitological study, the finding of high eosinophil blood count should suggest to perform fecal examinations and, eventually, administer antihelminthic treatment.
Helmintiasis intestinales. Eosinophilia is associated with HIV disease progression. Clinical Parasitology , 9th ed. Can eradication of helmintic infections change the face of AIDS and tuberculosis?
Immunol Today 20 : Immune dysregulation in Ethiopian immigrants in Israel: relevance to helminth infections? Clin Exper Immunol : Helminths, human immunodeficiency virus and tuberculosis. Scand J Infect Dis 33 : Persistencia de parasitosis intestinales endemicas en America Latina.
Bol Of Sanit Panam 90 : Good worms of bad worms: do worm infections affect the epidemiological patterns of other diseases? Parasitol Today 16 : Cryptosporidiosis among patients with acquired immunodeficiency syndrome in Zulia State, Venezuela.
Am J Trop Med Hyg 47 : Prevalence of Cryptosporidium sp. J Parasitol 79 : A redescription of Entamoeba histolytica Schaudinn, emended Walker, separating it from Entamoeba dispar Brumpt, J Euk Microbiol 40 : Economics and the argument for parasitic disease control.
Invasión masiva de la vía biliar por ascaris lumbricoides. Informede un caso
Key words:. Rev Mex Pediatr ; Tesis de Postgrado. Bedii S, Erzurum C. Management of intestinal obstruction caused by Ascaris. Br J Surg ;
Surgical complications of ascariasis
Geohelmintiasis: Más información