Evaluation of Diagnostic Techniques in Detection of Enteric Coccidian Parasites in Patients with HIV

Introduction: Diarrhoea is one of the commonest opportunistic infections seen in the course of the HIV disease and is a cause of considerable morbidity and mortality. Protozoan intestinal infections constitute one of the most important ailments affecting these immune deficient groups. Aim: To evaluate modified acid-fast staining technique with modified safranin technique in detection of enteric coccidian parasites and its correlation with Cluster of Differentiation (CD4) cell counts. Materials and Methods: A prospective cross-sectional study was done for a period of 16 months (November 2015 to March 2017) was conducted in 200 Human Immunodeficiency Virus (HIV) positive patients with diarrhoea in ABVIMS and Dr. RML hospital, Delhi, India. Three consecutive early morning stool samples (3-5 gm/3-5 mL) along with 3 mL venous blood in Becton Dickinson Ethylenediamine Tetra-Acetic Acid (BD EDTA) vial for CD4 cell estimation were collected. The smears were subjected to Kinyuon method and Modified Safranin Technique. Enzyme Linked Immunosorbent Assay (ELISA) for detection of Cryptosporidium antigen was also performed. All statistical analysis was performed using STATA version 16.1 software. Results: A total of 58 (29%) enteric coccidian parasites were detected. Isospora belli was the most common parasite in HIV positive patients followed by Cryptosporidium spp. The maximum parasitic isolation was in the patients with CD4 cell counts below 250 cells/μL. Conclusion: Routine screening of stool samples of HIV positive patients with diarrhoea should be undertaken for enteric coccidian parasites to prevent delay in diagnosis and prevention of morbidity and mortality associated with these infections.