Abstract :
Background: Fungal pathogens are the leading cause of severe healthcare-associated infections in immunocompromised patients, especially from low-income countries like Nigeria. Acquired Immunodeficiency Syndrome (AIDS) arising from HIV infection is reputed to be a key in immune suppression globally. Presently, Anambra state is number 5 in HIV prevalence in Nigeria. This study was aimed at screening patients from the Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, for fungal infections. Samples were collected with consideration to gender, age, occupation, education status and clinical presentations.
Methods: Sampling was done according to global best practices. Patients’ consent and details were obtained by signing a consent form and filling of questionnaires respectively. Key questionnaire details included sociodemographic and personal details, history of present illness, clinical signs and symptoms. All patients were screened afresh for HIV-1 and HIV-2 using an immuno-chromatographic technique with Determine kit (Alere, Japan) and Stat-pack kit (USA). Specimens screened include Urine, Blood, Oropharyngeal swab, Skin scraping, and Sputum. All samples were labeled, transported and processed within 1-2 hours of collection.
Results: A total of 1200 participants (610 males and 590 females) were examined. About 16.5% and 54.41% of the subjects examined were positive for HIV infections and fungal infections respectively. Overall, 233 males (19.41%) and 420 females (35.0%) had fungal infections. Fungal infections were most prevalent in patients between 30-39 years, 17.75%, followed by 40-49 years (15.0%). Infection was least prevalent in patients between 15-29 years at 5.0%. Farmers had the highest prevalence rate of fungal infection, though not significant when compared with those of traders, artisans and public servants (X2 =0.621; df=2; P>0.05). Candida species were the most prevalent fungal pathogen, accounting for 609 (67.1%) followed by Aspergillus spp. 234 (25.8%) and Cryptococcus species 31 (3.4%). Penicillium and Fusarium spp. were the least prevalent pathogens (1.9%). Oropharyngeal candidiasis was the most common fungal infection (49.9%-17.4% HIV negative and 32.46% HIV positive patients); followed by Pneumocystis pneumonia (28.80%-9.50% HIV negative and 19.30% HIV positive patients). Similarly, Cryptococcal meningitis was the least recorded infection at 16.81% (6.43% HIV negative and 10.38% HIV positive patients). Significantly, fungal infections were more prevalent in HIV infected patients (62.14%) compared to HIV negative patients (33.33%).
Conclusion: This study has revealed that HIV positive and negative patients are often affected with fungal infections in Anambra State, Nigeria. This may have contributed to impaired immune system in patients and development of AIDS in HIV infected patients. Poor personal hygiene and intimate association with household pets among subjects examined were the suspected sources of infection. Therefore, there is an urgent need for improved surveillance and monitoring of fungal infections in the area and in other Teaching Hospitals in the country as well as treatments of infected subjects.
Keyword :
Fungal pathogens, Immunocompromised, HIV patients,Healthcare-associated infections.