Intestinal protozoa in HIV-infected patients in Apulia, South Italy

Protozoa are important enteric pathogens in patients with human immunodefic iency virus (HIV) infection. In this study the prevalence of intestinal pro tozoa in 154 HIV-infected patients, with or without diarrhoea, in our regio n (Apulia, South Italy) was evaluated between December 1993 and February 19 98. In the majority of patients CD4+ T cell count was below 200/mu l. The o verall prevalence of intestinal protozoa was 43/154 (27.92%). Twenty-eight (43.08 %) out of 65 patients with diarrhoea and 15 (16.85 %) out of 89 non- diarrhoeic patients were parasitized. In particular, in the group of 65 pat ients with diarrhoea the following protozoa were identified: Cryptosporidiu m parvum in 14 (21.54 %), Blastocystis hominis in 7 (10.77 %), microsporidi a in 6 (9.23 %), Giardia lamblia in 4 (6.15 %) and Isospora belli in 1 (1.5 4%). Three patients were Cryptosporidium parvum-microsporidia co-infected. In patients without intestinal symptoms, prevalence was 3/89 (3.37 %) for C ryptosporidium parvum, 9/89 (10.11 %) for Blastocystis hominis, 1/89 (1.12 %) for microsporidia and 2/89 (2.25 %) for Giardia lamblia. A significant ( P < 0.001) correlation was observed between protozoan infection and the pre sence of diarrhoea. In particular, Cryptosporidium parvum and microsporidia infections were significantly (P < 0.001) and P = 0.046, respectively) ass ociated with diarrhoeal illness. Moreover, the majority of cases of cryptos poridiosis were first diagnosed in the periods of heaviest rainfall. Theref ore, drinking water contamination may be a possible source of human infecti on in our area.