Prevalence of isosporiasis in relation to CD4 cell counts among HIV-infected patients with diarrhea in Odisha, India


Department of Microbiology, ART Centre, M.K.C.G. Medical College, Berhampur, Odisha, India


Background: To determine the prevalence of Isospora belli and its correlation with CD4+ cell counts in HIV-positive patients with diarrhea in this region.
Materials and Methods: Stool samples from 250 HIV-positive patients, including 200 with diarrhea and 50 without diarrhea included in the study were examined for the presence of enteric parasites under microscopy. Prevalence of the enteric parasites with special reference to I. belli in HIV-positive patients with and without diarrhea were calculated and correlated with their CD4+ cell counts.
Results: Enteric parasites were detected in 39% of the HIV patients with diarrhea compared to 30% without diarrhea. I. belli was detected in 22% of the patients with diarrhea and in 4% without diarrhea (P = 0.0019). I. belli was the most common parasite, followed by Entamoeba histolytica/dispar (8%) and Cryptosporidium parvum (5%) in HIV-positive patients with diarrhea. In HIV-positive patients without diarrhea, the most common parasite detected was E. histolytica/dispar (12%) followed by C. parvum (6%) and I. belli (4%). The mean CD4 cell count of HIV-positive patients with diarrhea suffering from isosporiasis was 138.35 ± 70.71. In patients with CD4 cell counts <200/μl, I. belli was seen in 36/123 stool samples and 2/27 stool samples which was statistically significant (P = 0.0157).
Conclusion: I. belli was the predominant parasite with a prevalence of 22% among HIV-positive patients with diarrhea, majority having CD4 cell count <200/μl. This study highlights the importance of routine screening for coccidian parasites in HIV-positive patients with and without diarrhea especially in those with low CD4 cell counts.


1. Mukhopadhya A, Ramakrishna BS, Kang G, Pulimood AB, Mathan MM, Zachariah A, et al. Enteric pathogens in southern Indian HIV-infected patients with and without diarrhoea. Indian J Med Res 1999;109:85-9.  Back to cited text no. 1
2. Vignesh R, Balakrishnan P, Shankar EM, Murugavel KG, Hanas S, Cecelia AJ, et al. High proportion of isosporiasis among HIV-infected patients with diarrhea in southern India. Am J Trop Med Hyg 2007;77:823-4.  Back to cited text no. 2
3. Dwivedi KK, Prasad G, Saini S, Mahajan S, Lal S, Baveja UK. Enteric opportunistic parasites among HIV infected individuals: Associated risk factors and immune status. Jpn J Infect Dis 2007;60:76-81.  Back to cited text no. 3
4. Gupta S, Narang S, Nunavath V, Singh S. Chronic diarrhoea in HIV patients: Prevalence of coccidian parasites. Indian J Med Microbiol 2008;26:172-5.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5. Meisel JL, Perera DR, Meligro C, Rubin CE. Overwhelming watery diarrhea associated with a cryptosporidium in an immunosuppressed patient. Gastroenterology 1976;70:1156-60.  Back to cited text no. 5
6. Zali MR, Mehr AJ, Rezaian M, Meamar AR, Vaziri S, Mohraz M. Prevalence of intestinal parasitic pathogens among HIV-positive individuals in Iran. Jpn J Infect Dis 2004; 57: 268-70.  Back to cited text no. 6
7. Inabo HI, Aminu M, Muktar H, Adeniran S. Profile of intestinal parasitic infections associated with diarrhoea in HIV/AIDS patients in a tertiary care hospital in Zaria, Nigeria. World J Lifr Sci Med Res 2012;2:43-7.  Back to cited text no. 7
8. Akinbo FO, Okaka CE, Omoregie R. Prevalence of intestinal parasitic infections among HIV patients in Benin City, Nigeria. 2010; 5.  Back to cited text no. 8
9. Kulkarni SV, Kairon R, Sane SS, Padmawar PS, Kale VA, Thakar MR, et al. Opportunistic parasitic infections in HIV/AIDS patients presenting with diarrhoea by the level of immunesuppression. Indian J Med Res 2009;130:63-6.  Back to cited text no. 9
10. Basak S, Bose S, Mallick SK, Ghosh AK. Intestinal parasitic infections in HIV seropositive patients: A study. J Clin Diagn Res 2010;4:2433-7.  Back to cited text no. 10
11. Prasad KN, Nag VL, Dhole TN, Ayyagari A. Identification of enteric pathogens in HIV-positive patients with diarrhoea in northern India. J Health Popul Nutr 2000;18:23-6.  Back to cited text no. 11
12. Ramakrishnan K, Shenbagarathai R, Uma A, Kavitha K, Rajendran R, Thirumalaikolundusubramanian P. Prevalence of intestinal parasitic infestation in HIV/AIDS patients with diarrhea in Madurai City, South India. Jpn J Infect Dis 2007;60:209-10.  Back to cited text no. 12
13. Rao Ajjampur SS, Asirvatham JR, Muthusamy D, Gladstone BP, Abraham OC, Mathai D, et al. Clinical features and risk factors associated with cryptosporidiosis in HIV infected adults in India. Indian J Med Res 2007;126:553-7.  Back to cited text no. 13
14. Kumar SS, Ananthan S, Lakshmi P. Intestinal parasitic infection in HIV infected patients with diarrhoea in Chennai. Indian J Med Microbiol 2002;20:88-91.  Back to cited text no. 14
[PUBMED]  Medknow Journal  
15. Deorukhkar S, Katiyar R, Saini S, Siddiqui A. The prevalence of intestinal parasitic infections in HIV infected patients in a rural tertiary care hospital of western Maharashtra (a 5-year study). J Clin Diagn Res 2011;2:210-2.  Back to cited text no. 15
16. Vyas N, Pathan N, Aziz A. Enteric pathogens in HIV positive patients with diarrhoea and their correlation with CD4+T-lymphocyte counts. Trop Parasitol 2012;2:29-34. Available from: [Last assessed on 2012 Jul 03].  Back to cited text no. 16
17. Mohandas K, Sehgal R, Sud A, Malla N. Prevalence of intestinal parasitic pathogens in HIV-seropositive individuals in Northern India. Jpn J Infect Dis 2002;55:83-4.  Back to cited text no. 17
18. Adamu H, Petros B. Intestinal protozoan infections among HIV-positive persons with and without antiretroviral treatment (ART) in selected ART centers in Adama, Afar and Dire-Dawa, Ethiopia. Ethiop J Health Dev 2009;23:133-40.  Back to cited text no. 18
19. Assefa S, Erko B, Medhin G, Assefa Z, Shimelis T. Intestinal parasitic infections in relation to HIV/AIDS status, diarrhea and CD4 T-cell count. BMC Infect Dis 2009;9:155. Available from:[Last assessed on 2012 Jul 03].  Back to cited text no. 19
20. Ros E, Fueyo J, Llach J, Moreno A, Latorre X. Isospora belli infection in patients with AIDS in Catalunya, Spain. N Engl J Med 1987;317:246-7.  Back to cited text no. 20
21. Lagrange-Xélot M, Porcher R, Sarfati C, de Castro N, Carel O, Magnier JD, et al. Isosporiasis in patients with HIV infection in the highly active antiretroviral therapy era in France. HIV Med 2008;9:126-30.  Back to cited text no. 21
22. Mannheimer SB, Soave R. Protozoal infections in patients with AIDS. Cryptosporidiosis, isosporiasis, cyclosporiasis, and microsporidiosis. Infect Dis Clin North Am 1994;8:483-98.  Back to cited text no. 22