Epidemiological and clinical correlates of malaria-helminth co-infections in southern Ethiopia

Abstract

BackgroundIn many areas of the world, including Ethiopia, malaria and helminths are co-endemic, therefore, co-infections are common. However, little is known how concurrent infections affect the epidemiology and/or pathogenesis of each other. Therefore, this study was conducted to assess the effects of intestinal helminth infections on the epidemiology and clinical patterns of malaria in southern Ethiopia where both infections are prevalent.MethodsA cross-sectional study was conducted in 2006 at Wondo Genet Health Center and Bussa Clinic, southern Ethiopia. Consecutive blood film positive malaria patients (N=230) and malaria negative asymptomatic individuals (N=233) were recruited. Malaria parasite detection and quantification was diagnosed using Giemsa-stained thick and thin blood films, respectively. Helminths were detected using direct microscopy and formol-ether concentration techniques. Coarse quantification of helminths ova was made using Kato Katz method.ResultsThe over all magnitude of intestinal parasitic infection was high irrespective of malaria infection (67% among malaria positive patients versus 53.1% among malaria non-infected asymptomatic individuals). Trichuris trichiura infection was associated with increased malaria prevalence while increased worm burden of helminths as expressed by egg intensity was associated with increased malaria parasitaemia which could be a potential factor for development of severe malarial infection with the course of the disease. Majority (77%) of the subjects had multiple helminths infection. T. trichiura, Ascaris lumbricoides, Schistosoma mansoni, and hookworm infestation accounted for 64.5, 57.7 %, 28.4%, and 12.2% of the infections, respectively.ConclusionsPopulations in malaria-endemic areas of southern Ethiopia are multi-parasitized with up to four helminths. Mass deworming may be a simple practical approach in endemic areas in reducing the risk of severe malarial attack particularly for those at high risk of both infections.

Malaria Parasitemia in Febrile Patients Mono- and Coinfected with Soil-Transmitted Helminthiasis Attending Sanja Hospital, Northwest Ethiopia

“…Approximately 27% and 41% of the total population in Ethiopia live in high and low malaria transmission areas, . Moreover, most of the time, malaria and STHs infections share endemicity in Ethiopia [20][21][22]. Evidences suggested that the Plasmodium density had a heterogeneous association with different species of STHs in malaria-STHs-coinfected patients [23,24].…”

“…Kulito and Gilgel Gibe which suggested that STH infections especially hookworm aggravate the severity of malaria [21,29]. However, the finding was contradicted with the study conducted in Nigeria and Wondo Genet, Ethiopia [22,36]. These controversial results on mean Plasmodium density changes could have arisen due to the differences in the study groups, immune status of the study participants, differences in infecting Plasmodium species, differences in residence country, or complex nature of helminth and Plasmodium interaction when they coexist in a host.…”

Helminths and malaria co-infections are associated with elevated serum IgE

“…To detect malaria infections, 200 fields (the equivalent of 0.5 μl of thick blood film) were examined as described before [25]. Briefly, the parasite density was expressed per micro liter [μl] of blood assuming 8000 leucocytes per μl of blood.…”

Associations Between Helminth Infections, Plasmodium falciparum Parasite Carriage and Antibody Responses to Sexual and Asexual Stage Malarial Antigens

“…; however, this has not been consistent. For example, the prevalence and severity of malaria as well as Plasmodium falciparum parasitemia density has been reported to be higher 3,4 in some but lower 5,6 in other studies comparing helminth-infected subjects with those uninfected. Similarly, at the immunological level, there are conflicting reports regarding the effect of chronic helminth infections on the immune responses to Plasmodium spp.…”