Kinyoun Staining Feasible for Detection of Intestinal Parasites in Patients With HIV

Computer artwork of HIV in the bloodstream.
Cancer, particularly non-Hodgkin lymphoma, remains a leading cause of death in patients with HIV who are being treated with antiretroviral therapy.
Researchers evaluated the use of the Kinyoun staining technique for the detection of intestinal parasitic infections in patients with HIV.

In resource-limited settings, Kinyoun staining should be considered as a method to detect intestinal parasitic infections in patients with HIV, according to results of a study published in the International Journal of Infectious Diseases.

This single-center cross-sectional study included patients (N=163) with HIV infection enrolled at the Asella Teaching and Referral Hospital in Ethiopia. Researchers evaluated patients with (n=85) and without (n=78) self-reported diarrhea, defined as 3 or more loose bowel movements for at least 3 consecutive days. The researchers obtained stool and blood samples from each patient to assess for the presence of a parasitic infection. The samples were evaluated using wet mount light microscopy and Kinyoun staining, a modified acid-fast staining technique. Chi-square testing and multivariate logistic regression were used to determine risk factors for infection.

Among patients included in the analysis, 62.0% were women, the mean age was 38.2±10.7 years, the mean CD4+ cell count was 482 (range, 21-1742) cells/μL, and 90.2% were receiving combination antiretroviral therapy. In addition, 68.7% of patients lived in urban locations, 87.7% drank tap water, 17.8% regularly defecated in an open field, 25.2% reported repeat contact with animal excreta, 35.2% reported regularly eating uncooked food, and 11.0% had no access to latrine facilities.

A total of 30 patients were found to have an intestinal parasitic infection following stool analysis, indicating an overall prevalence of 18.4%. Of these patients, protozoa were detected in 21 and helminths in 9. The most commonly detected parasite was Cryptosporidium species (n=12), followed by Giardia lamblia (n=7). Compared with standard examination, more parasites were detected with Kinyoun staining (18.4% vs 11.0%; P <.001).

The researchers noted that CD4+ cell counts were significantly decreased among patients with cryptosporidiosis vs those without evidence of an opportunistic intestinal infection (236.2 vs 501.6 cells/μL; P =.002). Further analysis between patients with vs without parasitic infections showed that those with an infection were significantly more likely to self-report diarrhea (31.8% vs 3.8%; P <.001), repeat contact with cattle excreta (29.3% vs 14.8%; P =.03), and the habit of eating uncooked food (37.7% vs 9.1%; P =.001).In addition, patients with parasitic infections had lower CD4+ cell counts (<200 cells/uL; P =.01), and fewer were receiving combination antiretroviral therapy (P =.038).

Significant predictors for any parasitic infection included diarrhea (adjusted odds ratio [aOR], 9.28; 95% CI, 2.44-35.20; P =.001) and eating uncooked food (aOR, 4.90; 95% CI, 1.83-13.11; P =.002). In regard to cryptosporidiosis, the only significant predictor was a lower CD4+ cell count (aOR, 5.42; 95% CI, 1.48-19.73; P =.010).

These findings may have limited generalizability as consuming uncooked beef or vegetables is common in Ethiopian cuisine.

According to the researchers, “the implementation of stool concentration and Kinyoun staining techniques is feasible with low training effort despite limited resources.” They concluded that “the use of these techniques significantly increases the detection rate of intestinal parasites compared to standard examination.”

Reference

Mesfun MG, Fuchs A, Holtfreter MC, et al. The implementation of the Kinyoun staining technique in a resource-limited setting is feasible and reveals a high prevalence of intestinal cryptosporidiosis in HIV patients. Int J Infect Dis. 2022;122:130-135. doi:10.1016/j.ijid.2022.05.009