Intestinal microsporidiosis in diarrheal patients infected with human immunodeficiency virus-1 in Addis Ababa, Ethiopia.

Intestinal microsporidiosis is most commonly associated with persistent diarrhea in advanced AIDS cases. To determine the prevalence and clinical manifestations of this infection in HIV/AIDS patients, a single fresh stool sample and blood were collected from 243 (214 HIV-positive and 29 HIV-negative) diarrheal patients. The presence of intestinal microsporidiosis in the stool was determined by Uvitex-2B staining and a PCR-based detection method. HIV screening was done by using ELISA, and reactive samples were confirmed by Western blotting. The CD4+ cell count was analyzed using FACScan. Out of 243 diarrheal patients, 39 (16.0%) cases were positive for intestinal microsporidial infection by either of the methods used. Of the 39, only 18 cases positive by microscopy were also positive by PCR. Based on PCR and microscopic analyses the microsporidial parasites were identified as Enterocytozoon bieneusi (30), Ecephalitozoon intestinalis (6), and double infections (3). All microsporidia-positive cases were HIV-positive, and 92.3% had diarrhea for over 4 weeks. The diarrhea was watery in 79.5% of the patients. Weight loss >10% was recorded in 37 (94.9%) cases. The CD4+ cell count was <100 cells/mm(3) in 84.4% of subjects, and 59.4% of the patients had a CD4+ cell count of < or =50 cells/mm(3), with a mean of 22.8 cells/mm(3). This study revealed that intestinal microsporidiosis is a common cause of chronic diarrhea and severe weight loss in advanced AIDS patients in Ethiopia. This condition is attributable mainly to E. bieneusi. Thus, early diagnosis of intestinal microsporidiosis in HIV/AIDS patients would certainly be helpful in the understanding and management of diarrheal illness.

Cryptosporidium parvum and other instestinal parasites among diarrhoeal patients referred to EHNRI in Ethiopia.

The occurrence of intestinal parasites in patients referred to the Parasitology Laboratory of the Ethiopian Health and Nutrition Research Institute (EHNRI), was recorded for four consecutive years, 1998-2001. Based on the stool appearance i.e. watery, loose, muciod and bloody, 442 diarrhoeal samples were particularly selected to allow diagnosis of intestinal parasites with emphasis on coccidian intestinal parasites. Wet saline mounts and formol ether concentration method with logul's iodine were performed for the detection of cysts, ova, trophozoites and larvae of intestinal parasites. Modified Ziehel Nelseen staining of stool smears was used to identify Cryptosporidum parvum and Isospora belli. The overall detection rate was 79.4% (351/442). The spectrum of positivity with any protozoa was 54.3% (240/442) and helminthes 25.1% (111/442). Cryptosporidium parvum was identified in 92/442 (20.8%). Isopora belli was identified among 35/442 (7.9%): Entamoeba histolytica/dispar scored second with positivity rate of 17.0% (75/442) and Giardia lamblia was found in 38/442 (8.6%) stool samples. As compared to protozoan parasites, detection rate with helminthes was very low. Among the helminthes. Strongyloides stercoralis was found in 38/442 (8.6%). This information strengthens the importance of intestinal protozoan parasites with recognition of the opportunistic parasites as major causes of diarrhoea. Their role in HIV/AIDS patients cannot be over-emphasized. Further awareness for the need of establishing different parasitological techniques at health service giving centers would enhance better understanding and management of diarrhoeal illness.

Development of research capability in Ethiopia: the Ethio-Netherlands AIDS research project (ENARP): 1994-2002, achievements, scientific findings and project goals.

In 1992, HIV/AIDS researchers in Amsterdam, the Netherlands, were invited to work in partnership with researchers in Ethiopia to build an HIV/AIDS research infrastructure in Addis Ababa. This project, which began in 1994, was envisioned to contribute meaningfully to fighting the HIV pandemic in the decades to come. Its immediate objective was to establish an HIV research laboratory to serve international partnerships pursuing HIV vaccine research in Ethiopia and to support national health authorities fighting the HIV epidemic in Ethiopia. The overall goal was to develop research capacity at the Ethiopian Health and Nutrition Research Institute (EHNRI) by improving facilities, training technical and academic personnel (at PhD, MSc, and MPH level), establishing cohort studies to study HIV infection progression, and helping the government to implement a national HIV surveillance program. In the period 1994-2002, the projected HIV/AIDS research laboratory was built and several existing sections of EHNRI were renovated and upgraded. An active HIV-research program was established. Staff grew to more than 60, including three Ethiopian and three expatriate research/managers. Two PhD. students have graduated in immunology and virology (University of Amsterdam, 2000), and five are currently in training. Several technical persons were trained and over 19 MSc/MPH-programs were supported at Addis Ababa University (AAU). The first Ethiopian PhD graduate became the national program manager for ENARP. Two ENARP cohort studies and several HIV-prevalence studies have helped to document the severity of the HIV epidemic in Ethiopia, assisting national authorities in formulation of national and regional policies to prevent HIV transmission. Initial funding for ENARP from the Netherlands government was projected for eight years, to end by 2003. It was expected that management responsibilities would then be transferred from expatriate to Ethiopian staff and all ENARP activities integrated into EHNRI.