A study on cryptosporidiosis among HIV-positive patients presenting with diarrhoea from rural and urban areas in Rwanda

Abstract

Introduction: Cryptosporidiosis is a disease caused by Cryptosporidium species and it causes prolonged cholera-like diarrhoea in HIV infected patients once their CD4 cells count falls below 200cells/μl. This study sought to determine the prevalence of Cryptosporidium spp. infection in HIV positive patients with diarrhoea using a PCR method as gold standard and to compare the sensitivity and specificity of PCR to those of direct stool smears and stool smears after formal ether concentration when both are stained by modified ZN method. The study was conducted at three hospitals in Rwanda and involved 377 HIV positive patients presenting with diarrhoea from outpatients and inpatients. Results: The prevalence of Cryptosporidium spp. infection in HIV positive patients was 34.2% (129/377) after using the PCR method. Direct stool smear stained by modified ZN staining showed sensitivity of 66.6% and specificity of 100% while stool smears from formal ether concentration showed sensitivity of 98.4% and specificity of 100 %. Cryptosporidium infections were detected more frequently in urban 38.2% (100/262) than rural areas 25.2% (29/115), there was a significant association between Cryptosporidium spp. and in those who reported having had diarrhoea for more than 30 days 72% (18/25) and in patients with CD4 cell count of less than 200 cells per μl 51.8% (128/247). Cryptosporidium infection was not associated with occupation, marital status, sex, age, education, water source and to eating places (p>0.05) in this study. Conclusion: This study showed high association between HIV positive patients presenting with diarrhoea and Cryptosporidium spp. and recommend modified ZN method for staining of stool smears made after formal ether concentration when testing for Cryptosporidium spp.