Revista de SIDA e investigación clínica

Mycological Studies on the Sputa of HIV Positive Clients Attending HIV Clinic in Federal Medical Centre Owerri, Nigeria

Abstract

Nwako OF, Mbata GC, Ofondu EU, Nwako AB, Dozie INS and Nwako CA

Background: Human immune deficiency virus (HIV), the causative agent of Acquired Immune Deficiency Syndrome (AIDS) has remained a global cankerworm, with more impact in the sub-Saharan Africa. This virus destroys and depletes the human CD4 cells, leading to immune deficiency state and making the individual susceptible to opportunistic infections. Fungal opportunistic infections are among the common pathogens seen earlier in HIV positive individuals and may present as respiratory diseases like Pneumocystis jiroveci pneumonia and pulmonary cryptococcosis. This study aimed at understanding the pattern of fungal opportunists in the sputa of HIV positive individuals in our locality, to understand the demographics among those with the fungal isolates and to correlate CD4 level of the patients with the isolated opportunistic fungal pathogens.

Methods: This was a prospective study in design, study area was Federal Medical Centre Owerri, Imo state, Nigeria, and study population included HIV positive individuals who were older than fifteen (15) years who developed cough lasting for more than fourteen (14) days). The hospital is the largest in the state and serves some neighbouring states like Rivers, Anambra and Abia state. The sample size was seventy three (73). Samples were collected, processed and organisms identified and results tabulated.

Results: Out of the seventy three (73) sputa sample, 50 (68.5%) showed positive growth while twenty three 23 (31.5%) did not show any growth. Males with opportunistic fungal infections had a lower frequency (40%) than females (60%). 40/50 (80%) of the grown organisms were Candida organism and 23/40 (57.5%) of them were albicans. Candida albican had the highest incidence 23/50 (46%) and seen more in the age bracket (25-34). It was also rarely seen when the CD4 cell count was more than 500 cell/mm3 but very common when count was <400 cells/ mm3. Cryptococcus neoformans had 5/50 (10%) and isolated in individual with CD4 count<100 cells/mm3, Aspergillus flavus and A. fumigatus were isolated at 56 and 367 cells/mm3 with incidences of 2.0% respectively (Figure 1). The Penicillium marneffi reported as the emerging fungal infection among HIV clients in Southeast Asia was not seen in our series.

Conclusions: Most pulmonary fungal opportunistic infection in the setting of HIV often mimics pulmonary tuberculosis. Candida albicans has the highest incidence in our study. However, knowledge of fungal opportunistic infections pattern in HIV patients will help clinicians in the appropriate management of the clients—in terms of prophylaxis and therapeutics.