INTESTINAL PARASITES IN HIV-SEROPOSITIVE ZAMBIAN CHILDREN WITH DIARRHEA

We undertook a study over a period of 9 months to define the frequency of parasitic infections in hospitalized children with diarrhoea betwe en the ages of 15 months and 5 years. Every alternate day, mothers of all children admitted with diarrhoea between 09.00 hours and 12.00 hou rs to one of the wards of the Department of Pediatrics and Child Healt h of the University Teaching Hospital (UTH) in Lusaka, Zambia, were in terviewed for enrollment of their children into the study. A total of 178 children with diarrhoea were enrolled in the study. Of these 44 (2 5 per cent) were HIV seropositive and 134 (75 per cent) were seronegat ive for HIV. Out of 44 HIV-seropositive patients, 20 (45 per cent) had acute diarrhoea and 24 (55 per cent) had chronic diarrhoea. Of the 13 4 HIV-seronegative patients, 68 had acute diarrhoea (51 per cent) and 66 (49 per cent) had chronic diarrhoea. At least one intestinal parasi te was found in 34 out of the 178 children enrolled. The commonest par asites identified were Ascaris and Cryptosporidia. No associations wer e identified between parasite isolation and the following: age, sex, o r socio-economic status. Cryptosporidium spp, was isolated from 6 out of 44 (14 per cent) HIV-seropositive children, while 8 out of 134 (6 p er cent) seronegative children had the parasite (P = 0.01). HIV-seropo sitive children with chronic diarrhoea had significantly higher crypto sporidium identification rates than those HIV-seropositive children wi th acute diarrhoea [5 out of 24 (21 per cent) patients with chronic di arrhoea compared to 1 out of 20 (5 per cent) patients with acute diarr hoea; (P = > 0.01)]. In contrast, in HIV-seronegative patients, childr en with acute diarrhoea had significantly higher cryptosporidium ident ification rates than the children with chronic diarrhoea [7 were out o f 68 (10 per cent) children with acute diarrhoea and 1 out of 65 (2 pe r cent) children with chronic diarrhoea; P = 0.01]. This study of Zamb ian children with diarrhoea shows that parasites may explain a percent age of diarrhoea in HIV-seropositive children and, in these cases, was associated with more chronic symptomatology. A high proportion of chi ldren who had diarrhoea in the absence of identifiable parasitic infec tions suggests that other infectious agents or alternative mechanisms other than infections are responsible for the diarrhoea.