The Five Different Bacteria

Five different bacteria were isolated with 24.5% prevalence rate. The bacteria isolated include Klebsiella pneumoniae (37.93%), Pseudomonas aeruginous (31.04%), Escherichia coli (17.24%), Citrobacter freundi (6.89%) and Acinetobacter species (6.89%). This is similar to the study carried by Linet et al (2007), where K. pneumonia followed by P. aeruginosa were the most common Gram-negative bacilli isolated from LRTIs. Klebsiella pneumoniae, Pseudomonas aeruginous and Escherichil coli were reported each by Salami et al (2006) when immunity was severely compromised. But this result differ from the findings of Bola and Oluyege (2014) where E.

coli (72.5%) was the predominant isolation followed by Pseudomonas (53.3%), S aureus (20.0%) and least was Klebsiella pneumoniae (5%).

Out of total 26 microbial growth 11.53% polymicrobial growth was obtained while predominant monomicrobial growth was obtained in 88.46%. Polymicrobial infection is slightly higher among the HIV seropositive patients compared to normal populationas mentioned by Ojha et al (2015). The maximum number of patients under the study (n=68) were of active age group among which, 23.07% of young adults, 25% of active age group and old age group of patients were infected with the bacteria.

Relatively higher occurrence of LRTI among old age group can be attributed to weakening of immune system with age which renders them vulnerable to infection. Study conducted by Macfarlane et al (1993) also reported the increased incidence of LRTI among old age group.

Among different CD4 count categories, rate of LRTI was found significantly higher among the cases having CD4 cell count below 200 (37.89%), followed by CD4 count above 500 (18.18%) and those with in a range of 499-200 cells/µl (10.71%) This is statistically significant with p value ˂ 0.05%. This is similar to the study carried by Rimland et al (2002) where 67-89% of pneumonia occurred among patients with CD4 count ˂ 200 cells/µl.

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The lower the CD4 count the greater is the risk of acquiring LRTIs. Ojha et al (2015). Yadav and Satyam (2015) reported significantly higher rate of LRTIs among cases with CD4 count below 200 (63.4%) followed by those within 200-500 range categories (53.1%) and those within range above 500 (18.7%) which is higher than this study.

Tuberculosis is an important cause of pneumonia in HIV infected persons. Two out of 60 patients showed the presence of rifampicin-sensitive Mycobacterium tuberculosis detected by GeneXpert. In developed countries 1-16% of tuberculosis among hospitalized patients with pneumonia have been reported but it is a much more common problem in developing countries where it accounts for 47-75% cases of pneumonia in HIV-infected persons (Daley et al 1996).

Of all the antibiotics tested in this study Imipenim and Gentamycin was found out to be more effective against the reasonable percentage of bacteria isolates except for Acinetobacter spp and poorly sensitive toward the Cotrimoxazole. The major selective force favoring the emergence of antibiotic resistance is their extensive use. Cotrimoxazole, a WHO-recommended drug for the treatment of pneumonia was not effective against all the isolates except 100% of the Citrobacter freundii isolates that correlates with Bola and Oluyege (2014) ,where only 20% of klebsiella were sensetive toward cotrimoxazole and rest of the organisms isolated were resistant.This study also agreed with Adeleye et al. (2008) that reported Cotrimoxazole being strongly recommended by WHO as a primary or secondary prophylaxis for treatment of HIV bacterial infections in Africa was found to be resistant in Lagos, Nigeria.

In the study gram-negative bacteria were isolated and most of them were multidrug-resistant. Isolates were considerd as multidrug-resistant if it was resistant to at least two of the antibiotics of different class-tested (Sabtos et al 2007). Among total isolates 45% of them were ESBL producer and all the ESBL producers were MDR. Therefore this study highlight the emergence of ESBL producing strains endowed with extremely wide spectrum of antibiotic resistance. Decrease susceptibiliy of Gram-negative isolates toward third generations of cephalosporins cefotaxime, ceftriaxone and ceftazidime (5-40%) could be attributed to ESBL or Amp C beta-lactamase producers or some other relevent underlying mechanisms. ESBL production was most common among K pneumoniae (83.3%) followed by P aeruginosa (50%) and E coli (20%). Bacterial opportunistic pneumonia is the common disease reported in HIV-positive individual. The current study has demonstrated that lower respiratory tract infection as a common problem