title: Association between enteric protozoan parasites and gastrointestinal illness among HIV- and tuberculosis-infected individuals in the Chowke district, southern Mozambique.
abstract: Human immune deficiency virus (HIV) and tuberculosis (TB) infections remain major public health issues globally, particularly in sub-Saharan Africa. Impairment of both cell-mediated and humoral immunity by HIV and/or TB infections may limit the host's defences against other pathogens, including the diarrheagenic protozoan Cryptosporidium spp., Giardia intestinalis, and Entamoeba histolytica. During September-December 2015 a cross-sectional study was conducted to assess the prevalence and molecular diversity of these enteric parasites among HIV- and/or TB-infected patients at a medical reference centre in Chowke district, southern Mozambique. A total of 99 stool specimens were initially screened by direct microscopy and further confirmed and characterised by molecular methods. DNA sequence analyses of the genes encoding the small subunit ribosomal RNA and the 60-kDa glycoprotein were used for the typing and sub-typing of Cryptosporidium isolates, respectively. G. intestinalis-positive isolates by real-time PCR were subsequently typed at the glutamate dehydrogenase locus. Differential diagnosis of E. histolytica/dispar was achieved by real-time PCR. G. intestinalis (8.1%) was the enteric protozoan more frequently detected, followed by Cryptosporidium spp. (7.1%), and Entamoeba histolytica/dispar (6.1%). Two HIV-infected (but not TB-infected) patients harbour G. intestinalis and Cryptosporidium spp. co-infections. Two (29%) G. intestinalis isolates were successfully characterised, revealing the presence of known AII and novel BIV genotypes. Four (57%) Cryptosporidium isolates were unmistakeable assigned to C. hominis, identifying two (IbA10G2 and IdA22) sub-types. Cryptosporidium infections were not associated to diarrhoea in HIV-positive patients, probably because improved immune function in the affected individuals due to antiretroviral therapy. G. intestinalis was considered a non-opportunistic pathogen, whereas the presence of E. histolytica could not be confirmed by molecular methods. Based on their common presence in the studied clinical population, we recommend the effective diagnosis and treatment of these enteropathogens for improving the management of HIV and TB patients.
authors.affiliation: Department of Parasitology, Pharmacy Faculty, Valencia University, Av. Vicente Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Irisarri-Gutiérrez
authors.affiliation: Parasitology Service, National Centre for Microbiology, Carlos III Health Institute, Ctra. Majadahonda-Pozuelo Km 2, 28220, Majadahonda, Madrid, Spain.
authors.forename: Marta Hernández-de
authors.initials: MH
authors.lastname: Mingo
authors.affiliation: Parasitology Service, National Centre for Microbiology, Carlos III Health Institute, Ctra. Majadahonda-Pozuelo Km 2, 28220, Majadahonda, Madrid, Spain.
authors.forename: Aida
authors.initials: A
authors.lastname: de Lucio
authors.affiliation: Parasitology Service, National Centre for Microbiology, Carlos III Health Institute, Ctra. Majadahonda-Pozuelo Km 2, 28220, Majadahonda, Madrid, Spain; European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Granits väg 8, 171 65, Solna, Sweden.
authors.forename: Horacio
authors.initials: H
authors.lastname: Gil
authors.affiliation: Parasitology Service, National Centre for Microbiology, Carlos III Health Institute, Ctra. Majadahonda-Pozuelo Km 2, 28220, Majadahonda, Madrid, Spain.
authors.forename: Lucía
authors.initials: L
authors.lastname: Morales
authors.affiliation: Department of Parasitology, Pharmacy Faculty, Valencia University, Av. Vicente Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain.
authors.forename: Raimundo
authors.initials: R
authors.lastname: Seguí
authors.affiliation: Carmelo Hospital, Av. Trabalho, Chokwe, Gaza, Mozambique.
authors.forename: Edy
authors.initials: E
authors.lastname: Nacarapa
authors.affiliation: Department of Parasitology, Pharmacy Faculty, Valencia University, Av. Vicente Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain.
authors.forename: Carla
authors.initials: C
authors.lastname: Muñoz-Antolí
authors.affiliation: Division of Parasitology, Miguel Hernández University (UMH), Av. de la Universidad s/n, 03202, Elche, Alicante, Spain.
authors.forename: Fernando Jorge
authors.initials: FJ
authors.lastname: Bornay-Llinares
authors.affiliation: Department of Parasitology, Pharmacy Faculty, Valencia University, Av. Vicente Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain.
authors.forename: José Guillermo
authors.initials: JG
authors.lastname: Esteban
authors.affiliation: Department of Parasitology, Pharmacy Faculty, Valencia University, Av. Vicente Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain. Electronic address: dacarmena@isciii.es.
authors.forename: David
authors.initials: D
authors.lastname: Carmena
mesh_terms: D000818:Animals; D060085:Coinfection; D003430:Cross-Sectional Studies; D003457:Cryptosporidiosis / Q000469:parasitology; D003458:Cryptosporidium / Q000235:genetics / Q000302:isolation & purification; D004748:Entamoeba histolytica / Q000235:genetics / Q000302:isolation & purification; D005243:Feces / Q000469:parasitology; D005260:Female; D005767:Gastrointestinal Diseases / Q000469:parasitology*; D005838:Genotype; D016829:Giardia lamblia / Q000235:genetics / Q000302:isolation & purification; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D009073:Mozambique / Q000453:epidemiology; D010271:Parasites; D015995:Prevalence; D011528:Protozoan Infections / Q000453:epidemiology*; D060888:Real-Time Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D014376:Tuberculosis / Q000453:epidemiology*
keywords: Cryptosporidium; Diagnosis; Diarrhoea; Entamoeba; Enteric protozoan; Genotyping; Giardia intestinalis; HIV/AIDS; Mozambique; Tuberculosis