A Survey of Bacterial and Fungal Oppurtunistic Infections among HIV Clients in Kano Metropolis

Abstract

Ethical clearances from Aminu Kano Teaching Hospital Kano (AKTH) and Hospitals Management Board, Kano State were obtained and 600 patients were randomly selected, their informed consents obtained and tested for HIV by rapid tests using serial algorithm as recommended by World Health Organization and adopted by the Federal Ministry of Health. The biodata of the patients were collected confidentially and anonymously. All those confirmed to be HIV positive were further tested for CD4 cell count by flowcytometry technique (Pertec®) and were selected and screened for opportunistic bacterial and fungal pathogens using sputum samples. The bacterial pathogens were isolated using Blood and Chocolate agar plates and identified biochemically except the Acid Fast Bacilli (AFB) which was tested in all the HIV positive samples by Ziehl Neelson staining technique. The fungal pathogens were isolated using Sabouraud Dextrose Agar (SDA) with antibiotics and Brain Heart Infusion ( BHI ) Blood agar also with antibiotics and identified morphologically by wet microscopic mount. Results of this study showed that out of the 600 blood samples tested, 72 ( 12 % ) were HIV positive, 46 (7.7%) were male while 26 (4.3%) were female. On the basis of age groups, 30 – 40 years were found to have the highest number of HIV positive
(40%, n = 72), then followed by 15-20 years ( 40%, n = 72 ), while the lowest number was recorded among 5 – 14 years. CD4 cells count categorization by WHO showed highest number of
HIV positive among those with CD4 cells of ≥ 500 cells/ml with 37 cases (51% n = 72), then followed by those in the third category with CD4 count of ≤ 200 cell/ml (28%, n = 72) while in the category of 200 – 499 cell/ml, 15 cases (21% n= 72) were recorded. The overall organisms isolated among the 72 HIV positive patients were 139 as follows: Streptococcus pneumoniae (4%), Klebsiella pneumoniae (11%), Pseudomonas aerugenosa (19%), Haemophilus influenzae (4% ), Acid Fast Bacilli (23%), Candida albicans (26%), Aspergillus species (11%), Cryptococcus neoformans (1.4%), and Histoplasma capsulatum (0.6%). Highest number of the opportunistic pathogens was recorded in the ≤200 cell/ml CD4 category with 61 organisms while the other two categories both recorded 39 organisms each. In this study therefore, the number of the
opportunistic pathogens isolated among HIV positives indicates significant co-existence of polymicrobial infection due to immune suppression (p < 0.05). Also significant association was
found between low CD4 cells count of ≤200 cells/ml and the occurrence of major opportunistic bacterial and fungal pathogens such as Mycobacterium tuberculosis and Candida albicans ( p < 0.05) respectively.

Key words: HIV, AIDS, Bacteria, Fungi, Opportunistic pathogens, CD4 cells.