Prevalence, Features and Risk Factors for Malaria Co-Infections amongst Visceral Leishmaniasis Patients from Amudat Hospital, Uganda

Abstract

Background and methodologyDue to geographic overlap of malaria and visceral leishmaniasis (VL), co-infections may exist but have been poorly investigated. To describe prevalence, features and risk factors for VL-malaria co-infections, a case-control analysis was conducted on data collected at Amudat Hospital, Uganda (2000–2006) by Médecins sans Frontières. Cases were identified as patients with laboratory-confirmed VL and malaria at hospital admission or during hospitalization; controls were VL patients with negative malaria smears. A logistic regression analysis was performed to study the association between patients' characteristics and the occurrence of the co-infection.ResultsOf 2414 patients with confirmed VL, 450 (19%) were positively diagnosed with concomitant malaria. Most co-infected patients were males, residing in Kenya (69%). While young age was identified by multivariate analysis as a risk factor for concurrent VL and malaria, particularly the age groups 0–4 (odds ratio (OR): 2.44; 95% confidence interval (CI): 1.52–3.92) and 5–9 years (OR: 2.23, 95% CI: 1.45-3-45), mild (OR: 0.53; 95% CI: 0.32–0.88) and moderate (OR: 0.45; 95% CI: 0.27–0.77) anemia negatively correlated with the co-morbidity. VL patients harboring skin infections were nearly three times less likely to have the co-infection (OR: 0.35; 95% CI: 0.17–0.72), as highlighted by the multivariate model. Anorexia was slightly more frequent among co-infected patients (OR: 1.71; 95% CI: 0.96–3.03). The in-hospital case-fatality rate did not significantly differ between cases and controls, being 2.7% and 3.1% respectively (OR: 0.87; 95% CI: 0.46–1.63).ConclusionsConcurrent malaria represents a common condition among young VL patients living in the Pokot region of Kenya and Uganda. Although these co-morbidities did not result in a poorer prognosis, possibly due to early detection of malaria, a positive trend towards more severe symptoms was identified, indicating that routine screening of VL patients living in malaria endemic-areas and close monitoring of co-infected patients should be implemented.

Visceral Leishmaniasis-Malaria Coinfection and Their Associated Factors in Patients Attending Metema Hospital, Northwest Ethiopia: Suggestion for Integrated Vector Management

“…This is in agreement with the study which is conducted in India 5.9% among Indian patients with fever and splenomegaly [16]. However, this prevalence was lower as compared to study reported in Uganda 19% [25]. This variation might be due to difference in the VL and malaria prevalence which is 21.6% and 11.7% in this study and 57% and 31% in Uganda, respectively [25].…”

“…A similar finding was also reported in other studies [25–27]. The higher prevalence rate might be due to the fact that males engage in activities which make them more prone to infective mosquito and sand fly bites as compared to females who are mostly at home and protected from such infective bites.…”

“…However, this prevalence was lower as compared to study reported in Uganda 19% [25]. This variation might be due to difference in the VL and malaria prevalence which is 21.6% and 11.7% in this study and 57% and 31% in Uganda, respectively [25]. …”

Heterogeneity of Leishmania donovani Parasites Complicates Diagnosis of Visceral Leishmaniasis: Comparison of Different Serological Tests in Three Endemic Regions

“…In East African endemic regions, VL and malaria share the same geographical distribution [19], thus co-infections of VL and malaria are common in several countries, including Sudan [36]. It has recently been shown that malaria co-infections manipulate immune responses of co-infected hosts[37].…”

Clinical Research on Neglected Tropical Diseases: Challenges and Solutions

“…Additionally, a distinction was made between those NTDs that are thought to be controllable at the population level by means of mass drug administration (e.g., five to six rounds of albendazole plus ivermectin administered to all community members aged five years and above against lymphatic filariasis) and preventive chemotherapy (e.g., annual treatment of school-aged children with praziquantel against schistosomiasis) on one hand, and, on the other hand, those NTDs that involve individual case finding and management (e.g., Buruli ulcer) [9]. Recently, increasing attention has been given to the issues of co-endemicity, coinfection, and comorbidity [10–12], but generally, binary thinking prevails with regard to the identification, management, control, and elimination of NTDs. It should be noted, however, that for the patients suffering from those problems, the specific causal pathogens are of lesser importance.…”