Background: The Acquired Immunodeficiency Syndrome (AIDS) caused by Human Immunodeficiency Virus has spread so rapidly that it has now become a pandemic causing untold suffering and death, thus creating profound developmental challenges. The prevalence of HIV in Nigeria has been put at 5.0% (1). HIV epidemic has led to an increase in the incidence of opportunistic infections which are the most common causes of morbidity and mortality among HIV- infected individuals, especially those in advanced immunosuppression (2). The documented spectrum of opportunistic pathogens associated with HIV/AIDS ranges from viral, bacterial to fungal and parasitic, are reported to vary with geographical locations(3). The nature and frequency of these opportunistic infections are greatly dependent on the nature of the endemic diseases most prevalent in any particular area. Candidiasis, Cryptococcal meningitis and Pneumocystis carinii pneumonia are some of the most serious condition of AIDS. The dearth of information on the aetiology of fungal opportunistic infections in Nigeria informed this study which is aimed at identifying the fungal agents responsible for opportunistic infections in HIV/AIDS in Lagos, Nigeria. Methodology: A total number of 228 specimens comprising of 208 sputum samples, 15 oral swabs and 5 skin scrapings were collected from HIV/AIDS patients who presented with opportunistic infections at the three anti-retroviral centres in Lagos, Nigeria. The centres are the Lagos University Teaching Hospital (LUTH), Nigerian Institute of Medical Research (NIMR) clinic and Military Hospital Yaba, Lagos Nigeria. The specimens were cultured on Saboraud dextrose agar supplemented with Chloramphenicol antibiotic and incubated for 7-14 days at both room temperature and 37ºC. Identification o f the fungal cultures was done using the morphological features on the agar, sugar fermentation reactions, Giemsa staining reactions and urease production test. Potassium hydroxide and lacto phenol blue preparations were also examined microscopically for the identification. Results: Candida species (64.3%) were found to be the most common fungal pathogens causing pulmonary and skin infections in the patients. The nature and frequency of the pathogens isolated from 190 out of the 208 sputum samples showed Candida stellatoidea (22.1%), Candida tropicalis (21.2%), and Candida albicans (8.7%). Other species of Candida, Aspergillus species, Histoplasma capsulatum and Mucor were also isolated. For the oral swabs, Candida stellatoidea 4/15 (26.7%), was also the most prevalent while the skin scrapings grew different pathogens ranging from Candida stellatoidea, Candida albicans, Candida tropicalis, Candida krusei to Aspergillus niger. Conclusion: The results highlight the isolation of other species of Candida other than Candida albicans as the fungal pathogens causing opportunistic infections in HIV/AIDS patients contrary to earlier reports incriminating only Candida albicans. There is therefore the need to identify the fungal organisms causing opportunistic infections in each geographical location to avoid erroneous conclusions and also to help clinicians in the effective management of their patients. References: 1) Federal Ministry of Health [FMOH]: National HIV sero-prevalence Sentinel survey 2004, Public Health Department, National AIDS/STDS Control programme, Federal Ministry of Health Abuja Nigeria, 13-14. 2) Moore, RD and Chaisson, RE. Natural History of opportunistic diseases in an infected urban clinical cohort. Ann Interm. Med.1996 April 1, 124(7) 633-42. 3) Herner C.W. and Japper M.I. Opportunistic infection complicating Acquired Immune Deficiency Syndrome. Clinical features of 25 cases, Med.Baltimore 1984. 63:155-64. Corresponding Author: Dr. N. Idika.
Full conference title:
15th Annual Focus on Fungal Infections
- FFI 15th (2005)