Pattern of opportunistic infections and cytological changes in sputum specimens from HIV infected patients at Mbagathi District Hospital, Nairobi, Kenya

Abstract

Background information: Patients with advanced stages of HIV infection are vulnerable to secondary infections that are generally termed as opportunistic infections (OIs). This is because the microorganisms take advantage of the opportunity offered by a weakened immune system. Respiratory opportunistic infections commonly associated with HIV includes pneumococcal pneumonia, Pneumocystis jiroveci pneumonia and tuberculosis. Sputum is one of the specimens that can be utilized in making a rapid diagnosis of opportunistic infections. Objective: To describe the pattern of opportunistic infections and cytological changes in sputum specimens from HIV infected patients from Mbagathi District Hospital (MBH), TB Clinic, Nairobi, Kenya. Study design: A cross-sectional descriptive study. Setting: This study was conducted at MDH TB Clinic, Nairobi, Kenya, between February and June 2013. Study population: Adults 18 years and above attending MDH TB Clinic, who submitted sputum specimens for diagnosis of OIs diagnosis. Main Outcome Measures Age, gender, clinical information (coughing, chest pain, difficulty in breathing and loss of weight), correlation (CD4+ Lymphocytes), laboratory results (presence or absence of opportunistic infections and epithelial cellular changes) Material and methods: Demographic and clinical information was collected by direct interview of the patients. Two sputum samples per patient were obtained, pick and smear technique was used to prepare smears which were stained using Papanicolaou and Heamatoxylin and Eosin stain. The remainder of the sample was processed using bleach centrifugation method and stained with Ziehl Neelsen stain. Result: A total of 100 HIV infected patients were studied. Majority of the patients, (51%) were female, while remainder were male (49%). The mean age was 38.98 years (± 10), with a median (IQR) 193.5 cell/mm3 (134.3, 269.5). Inflammatory changes were seen in 57% of patients, atypical squamous cells of undetermined significance (ASCUS) in 4%, negative findings in 34%. and unsatisfactory smears were 5%. The commonest opportunistic pathogen was Mycobacterium species (30%) and Candida species (14%). Conclusion: Majority of these HIV infected patients had inflammatory changes in the sputum, with Mycobacterium, Candida and Aspergillus species the pathogens that were detected. Recommendations: Sputum cytology should be used for preliminary diagnoses of opportunistic pathogens before confirmatory test