Microbiological assessment reveals that Salmonella, Shigella and Campylobacter infections are widespread in HIV infected and uninfected patients with diarrhea in Mozambique

Delfina Fernandes Hlashwayo; Emília Virgínia Noormahomed; Leonilde Bahule; Constance Benson; Robert T Schooley; Betuel Sigaúque; Kim E Barrett; Custódio Gabriel Bila

doi:10.1371/journal.pgph.0001877

Microbiological assessment reveals that Salmonella, Shigella and Campylobacter infections are widespread in HIV infected and uninfected patients with diarrhea in Mozambique

PLOS Glob Public Health. 2023 May 22;3(5):e0001877. doi: 10.1371/journal.pgph.0001877. eCollection 2023.

Authors

Delfina Fernandes Hlashwayo^{1

2}, Emília Virgínia Noormahomed^{3

4

5}, Leonilde Bahule¹, Constance Benson⁴, Robert T Schooley⁴, Betuel Sigaúque⁶, Kim E Barrett⁷, Custódio Gabriel Bila²

Affiliations

¹ Department of Biological Sciences, Faculty of Sciences, Universidade Eduardo Mondlane, Maputo, MZ.
² Department of Animal Health & Epidemiology, Faculty of Veterinary Medicine, Universidade Eduardo Mondlane, Maputo, MZ.
³ Department of Microbiology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, MZ.
⁴ Division of Infectious Diseases, Department of Medicine, University of California, San Diego (UCSD), La Jolla, CA, United States of America.
⁵ Mozambique Institute for Health Education and Research (MIHER), Maputo, MZ.
⁶ Manhiça Health Research Center (CISM), Manhiça, MZ.
⁷ Department of Physiology and Membrane Biology, University of California Davis School of Medicine, Sacramento, CA, United States of America.

Abstract

Diarrhea is an important cause of hospitalizations in Mozambique. However, little attention has been paid to the impact HIV infection on the prevalence or clinical manifestations of enteric bacterial infections. This study aimed to determine the prevalence of Salmonella spp., Shigella spp. and Campylobacter spp. in HIV-infected and HIV-uninfected patients with diarrhea, identify risk factors for infection, and explore the association between HIV status, viral load, and bacterial prevalence. We conducted a case-control study at the Centro de Saúde de Mavalane and Centro de Saúde 1° de Maio in Maputo, Mozambique, from November 2021 to May 2022. We recruited 300 patients, including 150 HIV-infected (cases) and 150 HIV-uninfected patients (controls), aged between 0-88 years, presenting with diarrhea. Stool samples were collected for bacterial isolation through culture, and for each HIV-infected patient, 4 ml of venous blood were obtained for viral load detection through PCR. A total of 129 patients (43.0%) had at least one bacterial infection. The prevalence of Salmonella spp., Shigella spp. and Campylobacter spp. was 33.0% (n = 99), 15.0% (n = 45) and 4.3% (n = 13), respectively. The prevalence of any bacterial infection did not differ significantly between HIV-infected (45.3%, n = 68) and HIV-uninfected patients (40.7%, = 61) (p = 0.414). Overall, having 2-3 symptoms of enteric disease (p = 0.008) and a basic education (p = 0.030) were factors associated with bacterial infection. Of the 148 patients for whom HIV-1 RNA levels were available, 115 had copy numbers ≤ 75. Another 13 had levels between 76 and 1,000 and the remaining 20 had an average of 327,218.45 copies/ml. Bivariate logistic regression found that Shigella spp. were associated with HIV (p = 0.038), although no association was found in the multivariate analysis. Enteric infections are common in both HIV-infected and -uninfected patients. Low schooling influences the occurrence of enteric infections, which highlights the need to raise awareness about their prevention.

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Grants and funding

The research project, fellowship, manuscript writing, and publication were funded by the National Institutes of Health, Fogarty International Center under the award number D43TW010568 (to RTS). Additional support for manuscript writing was provided through the writing workshops carried with the support of the grant R25TW011216 (to EVN) also from the National Institutes of Health, Fogarty International Center. The authors are solely responsible for the content, which does not necessarily reflect the official views of the Fogarty International Center or the National Institute of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.