JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES

Durgarani A,Rajasekhar K,Rajyalakshmi G. A

Study of Opportunistic Infections
in HIV/AIDS Patients in and Around Kakinada, Andhrapradesh. J
Pharm Biomed Sci 2015; 05(01):53-56.

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Original article
A Study of Opportunistic Infections in
HIV/AIDS Patients in and Around
Kakinada , Andhrapradesh
Durgarani Arava1,*, Rajasekhar Koppada2, Rajyalakshmi Gunti3
Affiliation:-
1,3
Assistant professors, Department of Microbiology,
Rangaraya Medical College, Kakinada, Andhrapradesh, India
2
Assistant professor, Department of Microbiology,
Siddhartha Medical College, Vijayawada, India
The name of the department(s) and institution(s) to
which the work should be attributed:
Department of Microbiology, Rangaraya Medical College,
Kakinada, Andhrapradesh, India
Department of Microbiology, Siddhartha Medical College,
Vijayawada, India
Address reprint requests to
Dr. A. Durga Rani.
Assistant professor, Department of Microbiology, Rangaraya
Medical College, GGH Campus, Kakinada, Andhrapradesh.
PIN: 533001 or at durga_97@yahoo.com
Article citation:
Durgarani A, Rajasekhar K, Rajyalakshmi G. A study of
opportunistic infections in HIV/AIDS patients in and
around Kakinada, Andhrapradesh. J Pharm Biomed
Sci.2015;05(01):53-56.Available at www.jpbms.info
ABSTRACT
Aims & objectives: The present study was done to know
the prevalence of opportunisti c i nfections in s ymptoma tic
HIV seroposi ti ve and HIV seronega ti ve i ndi viduals in and
a round Ka kinada using simple laboratory s creening
methods. Material & methods: a total of 573 HIV
INTRODUCTION
I
ndia has the distinction of having the largest
number of people living with Human
Immunodeficiency virus (HIV) in the world.
Person infected with HIV dev elops into a case of
full blown AIDS by the appearance of a vari ety of
infections labelled as Opportunistic Infections 1.
In developing countries like India mycobacterium
tuberculosis ranks as the most common infection.
Oral and Oesophageal Candidi asis is the second
most common opportunistic infection followed by
Cryptosporidial diarrhoea, Herpes zoster,
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seropositi ve and 505 HIV seronega ti ve indi viduals were
s creened for opportunisti c pa thogens from Nov 2012 to
Oct 2014. The samples incl uded were s tool , sputum and
CSF. The methods adopted were saline & iodine wet
mounts, Acid fas t & modi fied Acid fast staining, India ink
prepa rati on and cul ture on Saboura ud’s Dextrose Agar
(SDA). Results : Out of 116 s tool samples from HIV
seropositi ve pa tients , 36 (31%) were found to be positi ve
for enteri c pa rasites . Among these Isospora belli was found
in 15 cases (13%), Cryptosporidium i n 10(8.6%),
Strongyloides stercoralis (SS) in 5 (4.3%). The posi ti vi ty in
HIV seronega ti ves was 5.8 %( 10 out of 171). A total
number of 339 sputum samples from HIV seropositi ve
pa tients and 334 sputum samples from HIV seronega tives
were tes ted for Mycobacterium tuberculosis (MTB). Out of
339 s putum samples 103 (30.3%) a mong HIV positi ve
pa tients and 54 out of 334 (16.1%) sputum samples in HIV
seronega ti ves were posi ti ve for MTB . A total of 118 CSF
samples were screened for Cryptococcus neoformans and 9
(7.6%) were found to be posi ti ve in HIV seropositi ves. No
requisitions were recei ved for Cryptococcus s creening in
HIV seronegati ve group. Conclusion: Though s yndrome
ma nagement is a better choi ce to trea t HIV/AIDS in
developing countries the routi ne labora tory methods of
s creening has a role in speci fi c diagnosis and treatment.
KEYWORDS: CNS Cryptococcosis ; Enteri c pa rasites;
Human immunodefi ciency vi rus ; pulmona ry tuberculosis.
Toxoplasmosis, Bacterial infection, PCP,
Cryptococcal meningitis and Kaposi Sarcoma.
In this prospective study an attempt was done to
know the prevalence of some opportunistic
infections like pulmonary tuberculosis, enteric
pathogens and CNS cryptococcosis in HIV/AID S
pati ents in and around Kakinada using simple
laboratory screening methods.
Diarrhoea is one of the mos t common presenting
complaints in HIV infected individuals. Several
species of protozoa hav e been associated with

acute and chronic diarrhoea in HIV disease. The
most commonly reported include Cryptosporidium
parvum, Isospora belli, Microsporidium species,
Giaradia intestinalis, and Cyclospora s pecies.
Besides these the nematode Stronglyloides
Stercoralis can caus e diarrhoea and overwhelming
infestation in HIV/AIDS patients 2.
Tuberculosis (TB) remains an important public
heal th problem in world that has been exacerbated
by the HIV epidemic resulting in i ncreased
morbidity and mortality 1. Tuberculosis infection
involves both pulmonary as well as extra
pulmonary.
Cryptococcus is the commonest central nervous
system fungal pathogen in immunocompromised
pati ents, particularly among those with AIDS3-5. It
is the fourth mos t commonly recognized caus e of
life threatening i nfection among these pati ents 6.
MATERIALS AND METHODS
A total number of 573 HIV seropositive and 505
seronegative individuals were screened for
opportunistic pathogens presenting with different
symptoms from November 2012 to October 2014
in an es tablished polyclinic at Kakinada.
Among the 573 s amples from HIV seropositives
116 were stool, 339 were sputum and 118 were
CSF samples. Among the 505 samples from HIV
seronegatives 171 were stool, 334 were sputum.
No requisitions were received for Cryptococcus
screening in s eronegative group.
Stool samples were screened for opportunistic
enteric parasites by Saline and Iodine wet mounts
and modified Acid Fast Staining.
Table 1. Opportunistic infections in HIV seropositives.
S.No Infection No. Tested No. Positive
1 Parasitic Diarrhoeas 116 36
2 Pulmonary tuberculosis 339 103
3 CNS Cryptococcosis 118 9 7.6
Total 573 148
Out of 573 samples tested 148 (25. 8%) were found to be positive for various opportunistic infections
among HIV seropositives of which parasitic diarrhoeas predominate followed by pulmonary tuberculosis
and CNS cryptococcosis.
Table 2. Opportunistic infections In HIV seronegatives.
No Infection No. Tested No. Positive
1 Parasitic Diarrhoeas 171 10
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Sputum samples were screened for Mycobacterium
tuberculosis by Acid Fast Staining.
CSF samples were screened for Cryptococcus
neoformans by Indi a ink preparation and culture
on Sabouraud’s Dextrose Agar.
RESULTS AND DISCUSSION
In our study, we noticed that intestinal parasitic
infections were the commonest (31%) followed by
pulmonary tuberculosis (30.3%) and CNS
Cryptococcosis (7.6%) among HIV positive
pati ents whereas in HIV seronegatives
Tuberculosis (16.1%) was found to be more
common than parasitic diarrhoeas(5.8%)
Among the enteric parasites Isospora belli was the
most common (41. 6%) followed by
Cryptosporidium (27. 7%) and Strongyloides
stercoralis larva (13.8%) among HIV seropositives.
This study is correlating with the resul ts of S.
Gupta et al. 2
In control group Cryptosporidium (30%) was the
commonest parasite followed by Isospora (20%).
Present study showed Pulmonary Tuberculosis in
HIV seropositives is 30.3% and in HIV
seronegatives i t is 16.6%. Srirangaraj et al.7 from
south India reported 68. 1% positivity.
Nine out of 118 (7. 6%) were positive for
Cryptococcus by India ink and culture on SDA i n
HIV seropositives. Another study 8 from Andhra
Pradesh showed 10.86% positivity which is
correlating with our study.
%
31
30.3
25.8
%
5.8
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2 Pulmonary tuberculosis 334 54 16.1

3 CNS cryptococcosis -- -- --
Total 505 64 12.6
Overall positivity for various opportunistic infections among HIV seronegatives was found to be 12.6%.

Table 3. Various enteric parasites In HIV seropositives & seronegatives.

HIV negative
S.NO PARASITE HIV positive % %

1 Isospora belli 15 41.6 2 20

2 Cryptosporidium 10 27.7
3 SS.larva 5 13.8
4 Cryptosporidium + Isospora 3 8.3
5 Isospora + SS.larva 2 5.5
6 Cryptosporidium +SS.larva 1 2.7
7 Isospora +Hookworm 0 -
8 EH cyst 0 -
9 Giardia 0 -
10 Hymenolepis 0 -
Total 36 31
3 30
0 -
1 10
0 -
0 -
1 10
1 10
1 10
1 10
10 5.8

Isospora belli was found to be the commonest cause of parasitic Diarrhoeas (41.6%) among HIV positive
pati ents followed by Cryptosporidium parvum (27.7%) and strongyloides stercoralis (13.8%).

Fi gure 1.Cryptosporidium parvum – Modi fied AFB stain Fi gure 2.Isospora belli - Modi fied AFB s tain (100X).
(100X).

Fi gure 3. Isospora belli – Saline mount (40 X). Fi gure 4.Strongyloides stercoralis - Saline mount (10 X).

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CONCLUSION
There are more patients presenting with
symptoms of respi ratory infections followed by
GIT and CNS infections. Enteric parasites are
detected more when compared to Mycobacteri um
species. Parasitic Infection with Isospora belli
seems to be more common than Cryptosporidium
parvum and SS infections. Parasites like
Hookworms, Entamoeba, and Giardia are seen only
in seronegative pati ents. Routine screening for
opportunistic infections in HIV positive individuals
is recommended to help i n an early diagnosis and
appropriate treatment as majority of patients
respond to therapy.
REFERENCES
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New Delhi.
2.S Gupta, S Narang, V Nunavath, S Singh. Chronic
diarrhea in HIV patients: Prevalence of coccidian
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Copyright © 2015. Durgarani A, Rajasekhar K, Rajyalakshmi. Th is is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original wo rk is p roperly
cited.
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NLM Title: J Pharm Biomed Sci.
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