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Aung PP, Han KT, Groot W, Biesma R, Thein ZW, Htay T, Lin Z, Aye KH, Adams M, Pavlova M. Heterogeneity in the prevalence of subclinical malaria, other co-infections and anemia among pregnant women in rural areas of Myanmar: a community-based longitudinal study. Trop Med Health 2024; 52:22. [PMID: 38459581 PMCID: PMC10921590 DOI: 10.1186/s41182-024-00577-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/05/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Due to the low prevalence of clinically suspected malaria among pregnant women in Myanmar, little is known about its impact on mothers and newborns. Helminth and Human Immuno-deficiency Virus (HIV) co-infections cause anemia in pregnant women. This study assessed the prevalence of subclinical malaria and co-infections among pregnant women, and its association with adverse outcomes of pregnancy in the presence of infection. METHODS A prospective longitudinal study was conducted in 12 villages in two townships in Myanmar between 2013 to 2015. A total of 752 pregnant women, with a mean age of 27 years, were enrolled and followed up once a month until six weeks after childbirth. Prevalence ratio was calculated in the multivariable analysis. RESULTS The prevalence of subclinical malaria as measured by nested PCR was 5.7% for either P. falciparum or P. vivax, 2.7% prevalence of P. falciparum and 2.8% prevalence of P. vivax. Helminth infections were prevalent in 17% of women, and one woman with an HIV infection was found in our study. The burden of anemia was high, with an overall prevalence of 37% with or without helminth infection, 42% of the women were malaria positive and 43% had dual infections (both malaria and helminth). Only 11 abnormal pregnancy outcomes (7 stillbirths, 2 premature, 2 twins) were identified. Poisson regression showed that women in their first trimester had a 2.9 times higher rate of subclinical malaria compared to women in the third trimester (PR:2.9, 95%CI 1.19, 7.31, p = 0.019), women who were enrolled during the wet season were 2.5 times more likely to be malaria positive than the women enrolled in the dry season (PR: 2.5, 95%CI 1.27, 4.88, p = 0.008), and the malaria positivity rate decreased by 5% when increased in one year of woman's age (PR:0.95, 95%CI 0.91, 0.99, p = 0.02). In the multivariable regression, the age of respondents was the only significant factor associated with subclinical malaria in pregnancy. CONCLUSIONS A comprehensive approach of integrating interventions for malaria, anemia, and helminths should be delivered during antenatal care services for pregnant women in rural areas of Myanmar.
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Affiliation(s)
- Poe Poe Aung
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
- Malaria Consortium, Bangkok, Thailand.
| | - Kay Thwe Han
- Department of Medical Research, Ministry of Health, Yangon, Myanmar
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Zaw Win Thein
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thura Htay
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zaw Lin
- National Malaria Control Program, Ministry of Health, Mandalay, Myanmar
| | - Kyin Hla Aye
- Department of Medical Research, Ministry of Health, Yangon, Myanmar
| | - Matthew Adams
- Malaria Research Program, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Lozano KJG, Gonçalves Santos E, Vilas Boas DF, Oliveira RRG, Diniz LF, Benedetti MD, Carneiro CM, C Bandeira L, Faria G, Gonçalves RV, Novaes RD, Caldas S, Caldas IS. Schistosoma mansoni co-infection modulates Chagas disease development but does not impair the effect of benznidazole-based chemotherapy. Int Immunopharmacol 2024; 128:111467. [PMID: 38211479 DOI: 10.1016/j.intimp.2023.111467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/05/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Abstract
The adequate management of parasite co-infections represents a challenge that has not yet been overcome, especially considering that the pathological outcomes and responses to treatment are poorly understood. Thus, this study aimed to evaluate the impact of Schistosoma mansoni infection on the efficacy of benznidazole (BZN)-based chemotherapy in Trypanosoma cruzi co-infected mice. BALB/c mice were maintained uninfected or co-infected with S. mansoni and T. cruzi, and were untreated or treated with BZN. Body weight, mortality, parasitemia, cardiac parasitism, circulating cytokines (Th1/Th2/Th17); as well as heart, liver and intestine microstructure were analyzed. The parasitemia peak was five times higher and myocarditis was more severe in co-infected than T. cruzi-infected mice. After reaching peak, parasitemia was effectively controlled in co-infected animals. BZN successfully controlled parasitemia in both co-infected and T. cruzi-infected mice and improved body mass, cardiac parasitism, myocarditis and survival in co-infected mice. Co-infection dampened the typical cytokine response to either parasite, and BZN reduced anti-inflammatory cytokines in co-infected mice. Despite BZN normalizing splenomegaly and liver cellular infiltration, it exacerbated hepatomegaly in co-infected mice. Co-infection or BZN exerted no effect on hepatic granulomas, but increased pulmonary and intestinal granulomas. Marked granulomatous inflammation was identified in the small intestine of all schistosomiasis groups. Taken together, our findings indicate that BZN retains its therapeutic efficacy against T. cruzi infection even in the presence of S. mansoni co-infection, but with organ-specific repercussions, especially in the liver.
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Affiliation(s)
- Kelly J G Lozano
- Department of Pathology and Parasitology, Federal University of Alfenas, 37130-001, Alfenas, MG, Brazil
| | - Elda Gonçalves Santos
- Department of Pathology and Parasitology, Federal University of Alfenas, 37130-001, Alfenas, MG, Brazil
| | - Diego F Vilas Boas
- Department of Pathology and Parasitology, Federal University of Alfenas, 37130-001, Alfenas, MG, Brazil
| | - Raphaela R G Oliveira
- Department of Pathology and Parasitology, Federal University of Alfenas, 37130-001, Alfenas, MG, Brazil
| | - Lívia F Diniz
- Department of Pathology and Parasitology, Federal University of Alfenas, 37130-001, Alfenas, MG, Brazil
| | - Monique D Benedetti
- Department of Pathology and Parasitology, Federal University of Alfenas, 37130-001, Alfenas, MG, Brazil
| | - Cláudia M Carneiro
- Laboratory of Immunopathology, Nucleus of Biological Sciences Research, Federal University, Ouro Preto 35400-000, MG, Brazil
| | - Lorena C Bandeira
- Laboratory of Immunopathology, Nucleus of Biological Sciences Research, Federal University, Ouro Preto 35400-000, MG, Brazil
| | - Gilson Faria
- Department of Research and Development., Ezequiel Dias Foundation, 30510-010, Belo Horizonte, MG, Brazil
| | - Reggiani V Gonçalves
- Department of Animal Biology, Federal University of Viçosa, Viçosa 36570-900, MG, Brazil
| | - Rômulo D Novaes
- Department of Structural Biology, Federal University of Alfenas, Alfenas 37130-000, MG, Brazil
| | - Sérgio Caldas
- Department of Research and Development., Ezequiel Dias Foundation, 30510-010, Belo Horizonte, MG, Brazil
| | - Ivo S Caldas
- Department of Pathology and Parasitology, Federal University of Alfenas, 37130-001, Alfenas, MG, Brazil.
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The influence of the host sex on parasitemia of parasite lineages belonging to Haemoproteus majoris in a natural bird community. Parasitol Res 2023; 122:895-901. [PMID: 36781472 DOI: 10.1007/s00436-023-07793-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
Immunological capability shows a sexual dimorphism in diverse animal species. Females are generally more immunocompetent than males, leading to the higher susceptibility of males to infection compared to females and thus greater infection-related pathology in males. These sex-differences in immunity remain understudied in birds. Here, we compared the percentage of parasitemia of three different parasite lineages belonging to the morphological species Haemoproteus majoris (namely, PARUS1, PHSIB1 and WW2) in terms of the sex of birds living in a natural community. We found that parasitemia (percentage of erythrocytes infected with parasites) of WW2 lineage, but not of the other two lineages of H. majoris, is higher in male birds compared to female birds. Similarly, we showed that the total parasitemia of these three H. majoris lineages is higher in male birds compared to female birds. Our study points out that male birds at the community level may be more susceptible to infection by certain parasites than female birds. We propose that sexual dimorphism in parasitemia of certain parasites in host birds might be more common than previously thought, similar to what is observed in other species, influencing host population dynamics in a sex-specific manner. Therefore, it can be speculated that infection by certain parasites might differentially affect male and female birds, possibly resulting in a bias in survival rates between sexes due to infections, in certain contexts.
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Briggs J, Murray M, Nideffer J, Jagannathan P. Sex-Linked Differences in Malaria Risk Across the Lifespan. Curr Top Microbiol Immunol 2023; 441:185-208. [PMID: 37695429 DOI: 10.1007/978-3-031-35139-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Despite the high burden of malaria worldwide, there is surprisingly scarce research on sex-based differences in malaria outside of pregnancy. A more thorough understanding of sexual dimorphism in malaria, and what underlies these sex-based differences, could elucidate the underlying mechanisms driving malaria pathogenesis and has the potential to inform malaria control efforts, including new vaccines. This review summarizes our current understanding of sex-based differences in the epidemiology of malaria across the lifespan, potential sex- or gender-based mechanisms driving these differences, and the knowledge gaps that need to be addressed.
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Affiliation(s)
- Jessica Briggs
- Department of Medicine, University of California, San Francisco, California, United States
| | - Margaret Murray
- Department of Medicine, University of California, San Francisco, California, United States
| | - Jason Nideffer
- Department of Medicine, Stanford University, Stanford, California, United States
| | - Prasanna Jagannathan
- Department of Medicine, Stanford University, Stanford, California, United States.
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Adukpo S, Adedoja A, Esen M, Theisen M, Ntoumi F, Ojurongbe O. Humoral antimalaria immune response in Nigerian children exposed to helminth and malaria parasites. Front Immunol 2022; 13:979727. [PMID: 36159869 PMCID: PMC9494551 DOI: 10.3389/fimmu.2022.979727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/16/2022] [Indexed: 11/14/2022] Open
Abstract
Background Malaria and helminthic parasites are endemic in tropical countries, and co-infections might influence host-parasite interactions. In this community-based cross-sectional study, the effect that the presence of soil-transmitted helminths (STH) (Hookworm, Hymenolepis nana) and Schistosoma haematobium infections could have on the immunoglobulin (Ig) candidate protein of the malaria vaccine GMZ2 levels was evaluated. Methods Blood, stool, and urine samples were collected from 5-15-year-old children to diagnose P. falciparum (Pf), STH, and Schistosoma haematobium, respectively. Identification and quantification of the parasite load of STH and S. haematobium were achieved by light microscopy. A polymerase chain reaction was carried out to detect submicroscopic infections of P. falciparum. Plasma levels of GMZ2 specific IgG and its subclasses were quantified by ELISA. Results The median level of total IgG in individuals with co-infection with Pf/H. nana was significantly lower in the mono-infected group with Pf (p = 0.0121) or study participants without infection (p=0.0217). Similarly, the median level of IgG1 was statistically lower in Pf/H. nana group compared to Pf-group (p=0.0137). Equally, the Pf/H. nana infected individuals posted a lower level of IgG1 compared to Pf-group (p=0.0137) and IgG4 compared to the Pf-group (p=0.0144). Spearman rank correlation analyses indicated positive relationships between the densities of H. nana (ρ=0.25, p=0.015) and S. haematobium (ρ=0.36, p<0.0001). Conclusions Hookworm and H. nana infections are associated with reduced GMZ2 specific IgG levels. This study shows the possible manipulation of immune responses by helminths for their survival and transmission, which may have serious implications for vaccine development and deployment in helminth-endemic regions.
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Affiliation(s)
- Selorme Adukpo
- Department of Pharmaceutics and Microbiology, School of Pharmacy, University of Ghana, Accra, Ghana
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Ayodele Adedoja
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Osogbo, Nigeria
- Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Meral Esen
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Michael Theisen
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Centre for Medical Parasitology at the Department of International Health, Immunology, and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Francine Ntoumi
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Infectious Disease Department, Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of Congo
| | - Olusola Ojurongbe
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Osogbo, Nigeria
- Centre for Emerging and Re-emerging Infectious Disease, Humboldt-Bayer Foundations Research Hub, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- *Correspondence: Olusola Ojurongbe,
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Afolabi MO, Adebiyi A, Cano J, Sartorius B, Greenwood B, Johnson O, Wariri O. Prevalence and distribution pattern of malaria and soil-transmitted helminth co-endemicity in sub-Saharan Africa, 2000-2018: A geospatial analysis. PLoS Negl Trop Dis 2022; 16:e0010321. [PMID: 36178964 PMCID: PMC9555675 DOI: 10.1371/journal.pntd.0010321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 10/12/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited understanding exists about the interactions between malaria and soil-transmitted helminths (STH), their potential geographical overlap and the factors driving it. This study characterised the geographical and co-clustered distribution patterns of malaria and STH infections among vulnerable populations in sub-Saharan Africa (SSA). METHODOLOGY/PRINCIPAL FINDINGS We obtained continuous estimates of malaria prevalence from the Malaria Atlas Project (MAP) and STH prevalence surveys from the WHO-driven Expanded Special Project for the Elimination of NTDs (ESPEN) from Jan 1, 2000, to Dec 31, 2018. Although, MAP provides datasets on the estimated prevalence of Plasmodium falciparum at 5km x 5km fine-scale resolution, we calculated the population-weighted prevalence of malaria for each implementation unit to ensure that both malaria and STH datasets were on the same spatial resolution. We incorporated survey data from 5,935 implementation units for STH prevalence and conducted the prevalence point estimates before and after 2003. We used the bivariate local indicator of spatial association (LISA analysis) to explore potential co-clustering of both diseases at the implementation unit levels among children aged 2-10 years for P. falciparum and 5-14 years for STH, living in SSA. Our analysis shows that prior to 2003, a greater number of SSA countries had a high prevalence of co-endemicity with P.falciparium and any STH species than during the period from 2003-2018. Similar prevalence and distribution patterns were observed for the co-endemicity involving P.falciparum-hookworm, P.falciparum-Ascaris lumbricoides and P.falciparum-Trichuris trichiura, before and after 2003. We also observed spatial variations in the estimates of the prevalence of P. falciparum-STH co-endemicity and identified hotspots across many countries in SSA with inter-and intra-country variations. High P. falciparum and high hookworm co-endemicity was more prevalent in West and Central Africa, whereas high P. falciparum with high A. lumbricoides and high P. falciparum with high T. trichiura co-endemicity were more predominant in Central Africa, compared to other sub-regions in SSA. CONCLUSIONS/SIGNIFICANCE Wide spatial heterogeneity exists in the prevalence of malaria and STH co-endemicity within the regions and within countries in SSA. The geographical overlap and spatial co-existence of malaria and STH could be exploited to achieve effective control and elimination agendas through the integration of the vertical control programmes designed for malaria and STH into a more comprehensive and sustainable community-based paradigm.
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Affiliation(s)
- Muhammed O. Afolabi
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Adekola Adebiyi
- College of Agriculture, Engineering and Environmental Design, Legacy University, Banjul, The Gambia
| | - Jorge Cano
- Expanded Special Project for Elimination of NTDs, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Benn Sartorius
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Department of Health Metric Sciences, University of Washington, Seattle, Washington, United States of America
| | - Brian Greenwood
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Olatunji Johnson
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
| | - Oghenebrume Wariri
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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Mahittikorn A, Masangkay FR, De Jesus Milanez G, Kuraeiad S, Kotepui M. Prevalence and effect of Plasmodium spp. and hookworm co-infection on malaria parasite density and haemoglobin level: a meta-analysis. Sci Rep 2022; 12:6864. [PMID: 35477943 PMCID: PMC9046215 DOI: 10.1038/s41598-022-10569-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/11/2022] [Indexed: 12/14/2022] Open
Abstract
The dual effects of co-infection of Plasmodium spp. and hookworm on malaria remain under debate. This study investigated prevalence, prevalence odds ratio (POR) of co-infection and impact of co-infection on malaria parasite density and haemoglobin levels in comparison to Plasmodium mono-infection. The protocol for this systematic review and meta-analysis is registered at PROPERO under ID: CRD42020202156. Relevant literatures were obtained from PubMed, ISI Web of Science, and Scopus on 25 December 2020. Mean difference (MD) and confidence interval (CI) of malaria parasite density and haemoglobin were compared using a random effect model. Heterogeneity was assessed using Cochrane Q and I2 statistics. Publication bias was determined by visualising funnel plot asymmetry. Of 1756 articles examined, 22,191 malaria cases across 37 studies included 6096 cases of co-infection of Plasmodium spp. and hookworm. The pooled prevalence was 20% (95% CI 15–26%, I2 99.6%, 37 studies) and was varied in terms of geographical region. Co-infection occurred by chance (OR 0.97, p 0.97, 95% CI 0.73–1.27, I2 95%, 30 studies). The mean malaria parasite density for co-infection (478 cases) was similar to Plasmodium mono-infection (920 cases) (p 0.24, MD 0.86, 95% CI − 0.58–2.29, I2 100%, 7 studies). The mean haemoglobin level for co-infection (90 cases) was similar to Plasmodium mono-infection (415 cases) (p 0.15, MD − 0.63, 95% CI − 1.49–0.23, I2 98%, 4 studies). Co-infection was common and occurred by chance but varied by geographic region. Further studies are required to investigate the mechanism of hookworm infection on malaria severity. Additionally, detection of hookworm infections among patients with malaria in endemic areas of both diseases is recommended to prevent severe malaria.
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Affiliation(s)
- Aongart Mahittikorn
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Giovanni De Jesus Milanez
- Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, Manila, Philippines
| | - Saruda Kuraeiad
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand
| | - Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
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Prevalence of Schistosoma mansoni and Associated Risk Factors in Human and Biomphalaria Snails in Ethiopia: A Systematic Review and Meta-analysis. Acta Parasitol 2022; 67:31-48. [PMID: 34259986 DOI: 10.1007/s11686-021-00449-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/28/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE Schistosomiasis is one of the leading chronic parasitic diseases in Ethiopia. We aimed to summarize the prevalence of S. mansoni in human and Biomphalaria snails as well as risk factors in Ethiopia. METHODS Literature search was carried out from Scopus, Google Scholar, Science Direct and PubMed which reported Schistosoma mansoni infection in human and Biomphalaria snails in Ethiopia. The overall prevalence was estimated by a random-effect model and heterogeneities among studies were assessed by I2 test. RESULTS A total of 178,251 participants and 1,097 snails were tested for the presence of S. mansoni in the eligible studies. The pooled prevalence of S. mansoni was 32.5% (95% CI 28.0-37.0) and 15.9% (95% CI - 5.6-37.5) in human and Biomphalaria snails in Ethiopia, respectively. The highest pooled prevalence was 43.2% (95% CI 27.3-59.1) in South Nations and National Peoples region while the lowest pooled prevalence was 25% (95% CI 19.3-30.7) observed in the Afar region. Interestingly, the pooled prevalence of S. mansoni declined from 40.7% (95% CI 33-48.4) to 22.4% (95% CI 18.5-26.3) after the launching of mass drug administration (MDA). The analysis of risk factors showed that swimming habit (OR, 2.78; 95% CI 2.35-3.21) and participation in irrigation (OR, 2.69; 95% CI 1.45-3.73) were independent predictors for S. mansoni infection. CONCLUSION This study revealed that about one-third of human and nearly 16% of Biomphalaria snails were infected with S. mansoni in Ethiopia. This review indicated that the prevalence of S. mansoni declined after the implementation of MDA. This study highlights the importance of further integrated approaches for better control of schistosomiasis in Ethiopia.
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Okiring J, Epstein A, Namuganga JF, Kamya EV, Nabende I, Nassali M, Sserwanga A, Gonahasa S, Muwema M, Kiwuwa SM, Staedke SG, Kamya MR, Nankabirwa JI, Briggs J, Jagannathan P, Dorsey G. Gender difference in the incidence of malaria diagnosed at public health facilities in Uganda. Malar J 2022; 21:22. [PMID: 35062952 PMCID: PMC8778495 DOI: 10.1186/s12936-022-04046-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Routine malaria surveillance data in Africa primarily come from public health facilities reporting to national health management information systems. Although information on gender is routinely collected from patients presenting to these health facilities, stratification of malaria surveillance data by gender is rarely done. This study evaluated gender difference among patients diagnosed with parasitological confirmed malaria at public health facilities in Uganda. METHODS This study utilized individual level patient data collected from January 2020 through April 2021 at 12 public health facilities in Uganda and cross-sectional surveys conducted in target areas around these facilities in April 2021. Associations between gender and the incidence of malaria and non-malarial visits captured at the health facilities from patients residing within the target areas were estimated using poisson regression models controlling for seasonality. Associations between gender and data on health-seeking behaviour from the cross-sectional surveys were estimated using poisson regression models controlling for seasonality. RESULTS Overall, incidence of malaria diagnosed per 1000 person years was 735 among females and 449 among males (IRR = 1.72, 95% CI 1.68-1.77, p < 0.001), with larger differences among those 15-39 years (IRR = 2.46, 95% CI 2.34-2.58, p < 0.001) and over 39 years (IRR = 2.26, 95% CI 2.05-2.50, p < 0.001) compared to those under 15 years (IRR = 1.46, 95% CI 1.41-1.50, p < 0.001). Female gender was also associated with a higher incidence of visits where malaria was not suspected (IRR = 1.77, 95% CI 1.71-1.83, p < 0.001), with a similar pattern across age strata. These associations were consistent across the 12 individual health centres. From the cross-sectional surveys, females were more likely than males to report fever in the past 2 weeks and seek care at the local health centre (7.5% vs. 4.7%, p = 0.001) with these associations significant for those 15-39 years (RR = 2.49, 95% CI 1.17-5.31, p = 0.018) and over 39 years (RR = 2.56, 95% CI 1.00-6.54, p = 0.049). CONCLUSIONS Females disproportionately contribute to the burden of malaria diagnosed at public health facilities in Uganda, especially once they reach childbearing age. Contributing factors included more frequent visits to these facilities independent of malaria and a higher reported risk of seeking care at these facilities for febrile illnesses.
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Affiliation(s)
- Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. .,Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda.
| | - Adrienne Epstein
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | - Jane F Namuganga
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Emmanuel V Kamya
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Isaiah Nabende
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Martha Nassali
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Asadu Sserwanga
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Samuel Gonahasa
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Mercy Muwema
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Steven M Kiwuwa
- Department of Child Health and Development Centre, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah G Staedke
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda.,School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Jessica Briggs
- Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Prasanna Jagannathan
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, USA
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, USA
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Dila KAS, Reda A, Elhady MT, Linh LK, Minh-Duc NT, El-Qushayri AE, Han NL, Mehta V, Hamad WMA, Eskarous H, Samsom M, Hirayama K, Huy NT. Association of anthelmintic treatment with malaria prevalence, incidence, and parasitemia: A systematic review and meta-analysis. Acta Trop 2022; 225:106213. [PMID: 34687649 DOI: 10.1016/j.actatropica.2021.106213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 11/29/2022]
Abstract
A chronic helminth infection can alter host immune response and affect malaria infection. We conducted a systematic review and meta-analysis to find the impact of anthelmintic treatment on malaria prevalence, incidence, and parasitemia. Nine and 12 electronic databases were searched on 28th July 2015 and 26th June 2020 for relevant studies. We performed meta-analysis for malaria prevalence, incidence, parasitemia, and a qualitative synthesis for other effects of anthelmintic treatment. Seventeen relevant papers were included. There was no association between anthelmintic treatment and malaria prevalence or change of parasitemia at the end of follow up period (pooled OR 0.93, 95% CI: 0.62, 1.38, p-value=0.71 and SMD -0.08, 95%CI: -0.24, 0.07, p-value=0.30 respectively) or at any defined time points in analysis. Pooled analysis of three studies demonstrated no association between malaria incidence and anthelmintic treatment (rate ratio 0.93, 95%CI: 0.80, 1.08, p-value=0.33). Our study encourages anthelmintic treatment in countries with high burden of co-infections as anthelmintic treatment is not associated with change in malaria prevalence, incidence, or parasitemia.
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Affiliation(s)
- Kadek Agus Surya Dila
- Pratama Giri Emas Hospital, Singaraja City, 81171 Buleleng, Bali, Indonesia; Online Research Club: http://www.onlineresearchclub.org/
| | - Ahmed Reda
- Online Research Club: http://www.onlineresearchclub.org/; Faculty of Pharmacy, Tanta University, Gharbia 31511, Egypt
| | - Mohamed Tamer Elhady
- Online Research Club: http://www.onlineresearchclub.org/; Department of Pediatrics, Zagazig University Hospital, Sharkia 44511, Egypt
| | - Le Khac Linh
- Online Research Club: http://www.onlineresearchclub.org/; College of Health Sciences, Vin University, Hanoi 100000, Vietnam
| | - Nguyen Tran Minh-Duc
- Online Research Club: http://www.onlineresearchclub.org/; University of Medicine and Pharmacy, Ho Chi Minh City 700000, Vietnam
| | - Amr Ehab El-Qushayri
- Online Research Club: http://www.onlineresearchclub.org/; Faculty of Medicine, Minia University, Minia 61519, Egypt
| | - Nguyen Lac Han
- Online Research Club: http://www.onlineresearchclub.org/; University of Medicine and Pharmacy, Ho Chi Minh City 700000, Vietnam
| | - Varshil Mehta
- Online Research Club: http://www.onlineresearchclub.org/; Internal Medicine Trainee, Department of Cardiology, Lister Hospital, Stevenage, United Kingdom
| | - Walid Mohamed Attiah Hamad
- Online Research Club: http://www.onlineresearchclub.org/; Departement of Internal Medicine, Zagazig University, Zagazig 44511, Egypt
| | - Hany Eskarous
- Online Research Club: http://www.onlineresearchclub.org/; Minya University, Faculty of Medicine, Egypt, Internal Medicine Resident, Easton Hospital, Easton City 18042, Pennsylvania
| | - Maryan Samsom
- Online Research Club: http://www.onlineresearchclub.org/; Internal Medicine Department, Faculty of Medicine, Egypt, Internal Medicine Resident, Jersey Shore University Medical Center, 07753 New Jersey, United States
| | - Kenji Hirayama
- School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan.
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11
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Watts C, Atieli H, Alacapa J, Lee MC, Zhou G, Githeko A, Yan G, Wiseman V. Rethinking the economic costs of hospitalization for malaria: accounting for the comorbidities of malaria patients in western Kenya. Malar J 2021; 20:429. [PMID: 34717637 PMCID: PMC8557520 DOI: 10.1186/s12936-021-03958-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria causes significant mortality and morbidity in sub-Saharan Africa, especially among children under five years of age and places a huge economic burden on individuals and health systems. While this burden has been assessed previously, few studies have explored how malaria comorbidities affect inpatient costs. This study in a malaria endemic area in Western Kenya, assessed the total treatment costs per malaria episode including comorbidities in children and adults. METHODS Total economic costs of malaria hospitalizations were calculated from a health system and societal perspective. Patient-level data were collected from patients admitted with a malaria diagnosis to a county-level hospital between June 2016 and May 2017. All treatment documented in medical records were included as health system costs. Patient and household costs included direct medical and non-medical expenses, and indirect costs due to productivity losses. RESULTS Of the 746 patients admitted with a malaria diagnosis, 64% were female and 36% were male. The mean age was 14 years (median 7 years). The mean length of stay was three days. The mean health system cost per patient was Kenyan Shilling (KSh) 4288 (USD 42.0) (95% confidence interval (CI) 95% CI KSh 4046-4531). The total household cost per patient was KSh 1676 (USD 16.4) (95% CI KSh 1488-1864) and consisted of: KSh 161 (USD1.6) medical costs; KSh 728 (USD 7.1) non-medical costs; and KSh 787 (USD 7.7) indirect costs. The total societal cost (health system and household costs) per patient was KSh 5964 (USD 58.4) (95% CI KSh 5534-6394). Almost a quarter of patients (24%) had a reported comorbidity. The most common malaria comorbidities were chest infections, diarrhoea, and anaemia. The inclusion of comorbidities compared to patients with-out comorbidities led to a 46% increase in societal costs (health system costs increased by 43% and patient and household costs increased by 54%). CONCLUSIONS The economic burden of malaria is increased by comorbidities which are associated with longer hospital stays and higher medical costs to patients and the health system. Understanding the full economic burden of malaria is critical if future malaria control interventions are to protect access to care, especially by the poor.
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Affiliation(s)
- Caroline Watts
- The Kirby Institute, University of New South Wales, Sydney, Australia. .,Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.
| | | | - Jason Alacapa
- The School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Ming-Chieh Lee
- Program in Public Health, University of California, Irvine, California, USA
| | - Guofa Zhou
- Program in Public Health, University of California, Irvine, California, USA
| | - Andrew Githeko
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Guiyun Yan
- Program in Public Health, University of California, Irvine, California, USA
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, Australia.,London School of Hygiene & Tropical Medicine, London, UK
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12
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Sumner KM, Mangeni JN, Obala AA, Freedman E, Abel L, Meshnick SR, Edwards JK, Pence BW, Prudhomme-O'Meara W, Taylor SM. Impact of asymptomatic Plasmodium falciparum infection on the risk of subsequent symptomatic malaria in a longitudinal cohort in Kenya. eLife 2021; 10:e68812. [PMID: 34296998 PMCID: PMC8337072 DOI: 10.7554/elife.68812] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Asymptomatic Plasmodium falciparum infections are common in sub-Saharan Africa, but their effect on subsequent symptomaticity is incompletely understood. Methods In a 29-month cohort of 268 people in Western Kenya, we investigated the association between asymptomatic P. falciparum and subsequent symptomatic malaria with frailty Cox models. Results Compared to being uninfected, asymptomatic infections were associated with an increased 1 month likelihood of symptomatic malaria (adjusted hazard ratio [aHR]: 2.61, 95% CI: 2.05 to 3.33), and this association was modified by sex, with females (aHR: 3.71, 95% CI: 2.62 to 5.24) at higher risk for symptomaticity than males (aHR: 1.76, 95% CI: 1.24 to 2.50). This increased symptomatic malaria risk was observed for asymptomatic infections of all densities and in people of all ages. Long-term risk was attenuated but still present in children under age 5 (29-month aHR: 1.38, 95% CI: 1.05 to 1.81). Conclusions In this high-transmission setting, asymptomatic P. falciparum can be quickly followed by symptoms and may be targeted to reduce the incidence of symptomatic illness. Funding This work was supported by the National Institute of Allergy and Infectious Diseases (R21AI126024 to WPO, R01AI146849 to WPO and SMT).
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Affiliation(s)
- Kelsey M Sumner
- Department of Epidemiology, Gillings School of Global Public Health, University of North CarolinaChapel HillUnited States
- Division of Infectious Diseases, School of Medicine, Duke UniversityDurhamUnited States
| | - Judith N Mangeni
- School of Public Health, College of Health Sciences, Moi UniversityEldoretKenya
| | - Andrew A Obala
- School of Medicine, College of Health Sciences, Moi UniversityEldoretKenya
| | - Elizabeth Freedman
- Division of Infectious Diseases, School of Medicine, Duke UniversityDurhamUnited States
| | - Lucy Abel
- Academic Model Providing Access to Healthcare, Moi Teaching and Referral HospitalEldoretKenya
| | - Steven R Meshnick
- Department of Epidemiology, Gillings School of Global Public Health, University of North CarolinaChapel HillUnited States
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North CarolinaChapel HillUnited States
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North CarolinaChapel HillUnited States
| | - Wendy Prudhomme-O'Meara
- Division of Infectious Diseases, School of Medicine, Duke UniversityDurhamUnited States
- School of Public Health, College of Health Sciences, Moi UniversityEldoretKenya
- Duke Global Health Institute, Duke UniversityDurhamUnited States
| | - Steve M Taylor
- Department of Epidemiology, Gillings School of Global Public Health, University of North CarolinaChapel HillUnited States
- Division of Infectious Diseases, School of Medicine, Duke UniversityDurhamUnited States
- Duke Global Health Institute, Duke UniversityDurhamUnited States
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13
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Hussen S, Assegu D, Tadesse BT, Shimelis T. Prevalence of Schistosoma mansoni infection in Ethiopia: a systematic review and meta-analysis. Trop Dis Travel Med Vaccines 2021; 7:4. [PMID: 33522949 PMCID: PMC7849146 DOI: 10.1186/s40794-020-00127-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/04/2020] [Indexed: 12/22/2022] Open
Abstract
Background Schistosomiasis is a common helminthic infection in the tropics and subtropics, particularly in sub-Saharan African countries including Ethiopia. In these counties, Schistosoma mansoni infection is a significant public health problem due to the risk of reinfection and recurrent disease despite implementing several rounds preventive chemotherapy. This systematic review and meta-analysis aimed at assessing the pooled prevalence of schistosomiasis in Ethiopia. Methods The PRISMA guidelines were followed to perform the systematic review and meta-analysis. Published studies from January 1999 to June 2020 were searched in Medline, PubMed, Google Scholar, EMBASE, HINARI, and Cochrane Library using key words including: “prevalence”, “incidence”, “schistosomiasis” “Bilharziasis”, “Bilharzia”, “S. mansoni “, “Ethiopia”. Heterogeneity of included studies was assessed using Cochran’s Q test and I2 test statistics while publication bias was assessed using Egger’s test. Results Ninety-four studies were included in the systematic review and meta-analysis. The pooled prevalence of S. mansoni in Ethiopia was 18.0% (95%CI: 14.0–23.0). The southern region of Ethiopia had a higher S. mansoni prevalence of 25.9% (995% CI, 14.9–41.1) than the national prevalence. The burden of S. mansoni infection was also higher than the national average in rural areas and among men with pooled prevalence of 20.2% (95% CI, 13.2–28.5) and 28.5% (95%CI, 22.7,35.1), respectively. The trend analysis showed that the prevalence of S. mansoni infection in Ethiopia decreased over the past 15 years, potentially because of the repeated preventive chemotherapy. Conclusion The review unveiled a moderate prevalence of S. mansoni infection in Ethiopia. Targeted treatment of at-risk population groups ad high burden areas coupled with implementation of integrated vector control strategies are critical to address the burden of Schistosomiasis. Supplementary Information The online version contains supplementary material available at 10.1186/s40794-020-00127-x.
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Affiliation(s)
- Siraj Hussen
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Demissie Assegu
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Birkneh Tilahun Tadesse
- School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Techalew Shimelis
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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14
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Comorbidity of Geo-Helminthes among Malaria Outpatients of the Health Facilities in Ethiopia: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030862. [PMID: 33498343 PMCID: PMC7908091 DOI: 10.3390/ijerph18030862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 01/15/2023]
Abstract
Background: Coinfection of malaria and intestinal helminths affects one third of the global population, largely among communities with severe poverty. The spread of these parasitic infections overlays in several epidemiological locations and the host shows different outcomes. This systematic review and meta-analysis determine the pooled prevalence of malaria and intestinal helminthiases coinfections among malaria suspected patients in Ethiopia. Methods: Primary studies published in English language were retrieved using appropriate search terms on Google Scholar, PubMed/MEDLINE, CINHAL, Scopus, and Embase. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. A pooled statistical meta-analysis was conducted using STATA Version 14.0 software. The heterogeneity and publication bias were assessed using the I2 statistics and Egger’s test, respectively. Duval and Tweedie’s nonparametric trim and fill analysis using the random-effect analysis. The Random effects model was used to estimate the summary prevalence of comorbidity of malaria and soil transmitted helminthiases and the corresponding 95% confidence intervals (CI). The review protocol has registered in PROSPERO number CRD42019144803. Results: We identified ten studies (n = 6633 participants) in this study. The overall pooled result showed 13% of the ambulatory patients infected by malaria and intestinal helminths concurrently in Ethiopia. The pooled prevalence of Plasmodium falciparum and Plasmodium vivax, and mixed infections were 12, 30, and 6%, respectively. The most common intestinal helminth parasites detected were Hookworm, Ascaris lumbricoides, and Tirchuris trichiura. Conclusions: The comorbidity of malaria and intestinal helminths causes lower hemoglobin level leading to maternal anemia, preterm delivery, and still birth in pregnant women and lactating mother. School-aged children and neonates coinfected by plasmodium species and soil transmitted helminths develop cognitive impairment, protein energy malnutrition, low birth weight, small for gestational age, and gross motor delay. The Ministry of Health of Ethiopia and its international partners working on malaria elimination programs should give more emphasis to the effect of the interface of malaria and soil transmitted helminths, which calls for an integrated disease control and prevention.
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15
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Briggs J, Teyssier N, Nankabirwa JI, Rek J, Jagannathan P, Arinaitwe E, Bousema T, Drakeley C, Murray M, Crawford E, Hathaway N, Staedke SG, Smith D, Rosenthal PJ, Kamya M, Dorsey G, Rodriguez-Barraquer I, Greenhouse B. Sex-based differences in clearance of chronic Plasmodium falciparum infection. eLife 2020; 9:59872. [PMID: 33107430 PMCID: PMC7591246 DOI: 10.7554/elife.59872] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/13/2020] [Indexed: 11/13/2022] Open
Abstract
Multiple studies have reported a male bias in incidence and/or prevalence of malaria infection in males compared to females. To test the hypothesis that sex-based differences in host-parasite interactions affect the epidemiology of malaria, we intensively followed Plasmodium falciparum infections in a cohort in a malaria endemic area of eastern Uganda and estimated both force of infection (FOI) and rate of clearance using amplicon deep-sequencing. We found no evidence of differences in behavioral risk factors, incidence of malaria, or FOI by sex. In contrast, females cleared asymptomatic infections at a faster rate than males (hazard ratio [HR]=1.82, 95% CI 1.20 to 2.75 by clone and HR = 2.07, 95% CI 1.24 to 3.47 by infection event) in multivariate models adjusted for age, timing of infection onset, and parasite density. These findings implicate biological sex-based differences as an important factor in the host response to this globally important pathogen.
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Affiliation(s)
- Jessica Briggs
- Department of Medicine, University of California San Francisco, San Francisco, United States
| | - Noam Teyssier
- Department of Medicine, University of California San Francisco, San Francisco, United States
| | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - John Rek
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Emmanuel Arinaitwe
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.,Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Margaret Murray
- Department of Medicine, Stanford University, Palo Alto, United States
| | | | - Nicholas Hathaway
- Department of Medicine, University of Massachusetts, Amherst, United States
| | - Sarah G Staedke
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Smith
- Institute for Health Metrics & Evaluation, University of Washington, Seattle, United States
| | - Phillip J Rosenthal
- Department of Medicine, University of California San Francisco, San Francisco, United States
| | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, United States
| | | | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, United States
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16
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Chronic inflammation was a major predictor and determinant factor of anemia in lactating women in Sidama zone southern Ethiopia: A cross-sectional study. PLoS One 2020; 15:e0240254. [PMID: 33017433 PMCID: PMC7535025 DOI: 10.1371/journal.pone.0240254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022] Open
Abstract
Anemia in women of reproductive age is highly prevalent globally and remains a public health problem. In Ethiopia, despite efforts to minimize the burden of anemia, it is still a moderate public health problem. Anemia has various etiologies including nutritional deficiency, parasitic infection, and inflammation. The aim of this study was to examine contributing factors to anemia in lactating women. Following ethical approval, and six months after delivery, all lactating women (n = 150) were recruited to participate in this study from eight randomly selected rural villages. Anthropometric and socio-economic factors were assessed. From each, a blood sample was collected for measuring hemoglobin, iron biomarkers, zinc, selenium, and inflammation markers. The median (IQR) hemoglobin (Hb) was 132 (123, 139) g/L. Of the women, 19% were anemic and 7% had iron deficiency anemia; 31% were iron deficient and 2% had iron overload. Also, 8% had functional iron deficit, 6% had acute inflammation, 13% had chronic inflammation, and 16% had tissue iron deficiency. The majority (78%) of the women had low plasma zinc out of which more than 16% were anemic. Hb was positively associated with plasma iron and plasma zinc and negatively associated with transferrin receptor (TfR) and α-1-acid glycoprotein (AGP). Plasma iron, AGP, TfR, hepcidin and plasma zinc were significant predictors of maternal anemia. Additionally MUAC and level of education were associated positively with maternal hemoglobin. This study showed that maternal anemia was associated with multiple factors including nutritional deficiencies, inflammation and limited education.
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17
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Mei X, Ye Z, Chang Y, Huang S, Song J, Lu F. Trichinella spiralis co-infection exacerbates Plasmodium berghei malaria-induced hepatopathy. Parasit Vectors 2020; 13:440. [PMID: 32883347 PMCID: PMC7469358 DOI: 10.1186/s13071-020-04309-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/24/2020] [Indexed: 11/11/2022] Open
Abstract
Background Although Plasmodium parasites and intestinal helminths share common endemic areas, the mechanisms of these co-infections on the host immune response remain not fully understood. Liver involvement in severe Plasmodium falciparum infections is a significant cause of morbidity and mortality. However, the effect of pre-existing Trichinella spiralis infection on the immune response and liver immune-pathogenesis in P. berghei ANKA (PbANKA)-infected mice needs to be elucidated. Methods Outbred Kunming mice were infected with T. spiralis and 9 days later were challenged with P. berghei ANKA (PbANKA), and the investigation occurred at 13 days after co-infection. Results Compared with PbANKA-mono-infected mice, T. spiralis + PbANKA-co-infected mice had similar survival rate but lower PbANKA parasitaemia; however, there were more severe hepatosplenomegaly, increased liver and spleen indexes, and increased liver pathology observed by hematoxylin and eosin staining; higher expression levels of galectin (Gal)-1, Gal-3, CD68+ macrophages, and elastase-positive neutrophils measured by immunohistochemical staining; upregulated mRNA expression levels of Gal-1, Gal-3, cytokines (interferon-gamma (IFNγ) and interleukin (IL)-6), and M1 macrophage polarization marker (inducible nitric oxide synthase (iNOS)) in the liver, and increased expression levels of Gal-1, IFNγ, IL-6, eosinophil cationic protein, eosinophil protein X, and M1 (IL-1β and iNOS) and M2 (Ym1) macrophage polarization markers in the spleen of co-infected mice detected by using quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). In vitro study showed that compared with PbANKA-mono-infected mice, there were significantly increased expression levels of Gal-1, Gal-3, IL-6, IL-1β, and iNOS in the peritoneal macrophage isolated from co-infected mice detected by using qRT-PCR. Correlation analysis revealed significant positive correlations between Gal-3 and IL-1β in the peritoneal macrophages isolated from PbANKA-mono-infected mice, between Gal-3 and IFNγ in the spleen of co-infected mice, and between Gal-1 and Ym1 in the peritoneal macrophages isolated from co-infected mice. Conclusions Our data indicate that pre-existing infection of T. spiralis may suppress P. berghei parasitaemia and aggravate malaria-induced liver pathology through stimulating Gal-1 and Gal-3 expression, activating macrophages, neutrophils, and eosinophils, and promoting mediator release and cytokine production.![]()
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Affiliation(s)
- Xu Mei
- Artemisinin Research Center and Institute of Science and Technology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhanhong Ye
- Department of Parasitology, Zhongshan School of Medicine; Key Laboratory of Tropical Disease Control of Ministry of Education, Sun Yat-sen University, Guangzhou, China
| | - Yuqing Chang
- Artemisinin Research Center and Institute of Science and Technology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shiguang Huang
- School of Stomatology, Jinan University, Guangzhou, China.
| | - Jianping Song
- Artemisinin Research Center and Institute of Science and Technology, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Fangli Lu
- Department of Parasitology, Zhongshan School of Medicine; Key Laboratory of Tropical Disease Control of Ministry of Education, Sun Yat-sen University, Guangzhou, China.
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18
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Murambiwa P, Silas E, Mdleleni Y, Mukaratirwa S. Chemokine, cytokine and haematological profiles in Sprague-Dawley rats co-infected with Plasmodium berghei ANKA and Trichinella zimbabwensis-A laboratory animal model for malaria and tissue-dwelling nematodes co-infection. Heliyon 2020; 6:e03475. [PMID: 32140591 PMCID: PMC7044667 DOI: 10.1016/j.heliyon.2020.e03475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/10/2020] [Accepted: 02/10/2020] [Indexed: 12/12/2022] Open
Abstract
Malaria remains a major cause of mortality and morbidity in sub-Saharan Africa (SSA) and tissue-dwelling helminth parasites (TDHPs) are also prevalent in this region presenting a geographical overlap in endemicity. There is paucity of information on the specific host immune responses elicited at different phases of the life cycle by the co-infecting helminth parasites. This study aimed at using a laboratory animal model to determine selected chemokine, cytokine and hematological profiles in Sprague-Dawley rats co-infected with Plasmodium berghei ANKA (Pb) and a tissue-dwelling nematode, Trichinella zimbabwensis (Tz). One-hundred-and-sixty-eight male Sprague-Dawley rats (90–150g) were randomly divided into four experimental groups; Control (n = 42), Pb-infected (n = 42), Tz-infected (n = 42) and Pb + Tz-infected group (n = 42). Trichinella zimbabwensis infection (3 muscle larvae/g body weight per os) was done on day 0 while intra-peritoneal Pb infection (105 parasitised RBCs) was done at day 28 of the 42-day experimental study for the co-infection group which corresponded with day 0 of the Pb group on the protocol. Haematological parameters, cytokines (TNF-α, IL-10, IL-4, IL-6), chemokines (CXCL10, CCL5, CCL11) and burden of Tz adult worms and muscle larvae burden were determined as per need for each group. Results showed that Tz infection predisposed the co-infected animals towards rapid development of Pb parasitaemia during co-infection, reaching a higher peak percentage parasitaemia at day 7 post-infection than the Pb mono-infected group at day 6 post-infection. Animals in the co-infected group also exhibited severe anaemia, basophilia, neutrophilia, eosinophilia and lymphopenia at day 7 post Pb infection compared to the control groups. Significant elevation of Pb parasitaemia coincided with elevated pro-inflammatory cytokine TNF-α (P < 0.001), regulatory anti-inflammatory IL-10 (P < 0.001), and pro-inflammatory chemokines CXCL10 (P < 0.001) concentration in comparison to control group, at day 7 post Pb infection. Our results confirm that co-infection of Pb with Tz resulted in increased Pb parasitaemia compared to the control group in the early stages of infection and this might translate to severe malaria.
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Affiliation(s)
- Pretty Murambiwa
- School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4000, South Africa
| | - Ekuyikeno Silas
- School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4000, South Africa
| | - Yanga Mdleleni
- School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4000, South Africa
| | - Samson Mukaratirwa
- School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4000, South Africa.,One Health Center for Zoonoses and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
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19
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Malaria Parasitemia in Febrile Patients Mono- and Coinfected with Soil-Transmitted Helminthiasis Attending Sanja Hospital, Northwest Ethiopia. J Parasitol Res 2020; 2020:9891870. [PMID: 32089868 PMCID: PMC7024094 DOI: 10.1155/2020/9891870] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/20/2019] [Accepted: 01/13/2020] [Indexed: 11/18/2022] Open
Abstract
Background Malaria is a life-threatening disease associated with high morbidity and mortality. Helminths are among the most widespread infectious agents prevalent in tropical and subtropical regions of the developing world. Malaria and soil-transmitted helminthiasis (STHs) are coendemic and major public health problems in Ethiopia. The effects of helminth coinfection on malaria parasitemia remained poorly understood. Therefore, the objective of this study was to assess malaria parasitemia among malaria-monoinfected and malaria-soil-transmitted helminthiasis-coinfected febrile patients attending Sanja Hospital, Northwest Ethiopia. Methods A cross-sectional study with parallel groups was conducted to assess malaria parasitemia among malaria-monoinfected and malaria-soil-transmitted helminthiasis-coinfected febrile patients in Sanja Hospital from January to March 2019. Double population proportion formula was used for sample size calculation, and convenient sampling technique was used to select 134 study participants. Data were entered and analyzed by using the Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics, independent t-test, and one-way analysis of variance (ANOVA) were performed. A P value of <0.05 was considered as statistically significant. Results From 134 malaria-positive study participants, 67 were malaria-monoinfected and 67 were malaria-STHs-coinfected patients. Out of 67 malaria STHs-coinfected patients, 54 (80.6%) were infected with hookworm followed by Ascaris lumbricoides 11 (16.4%) and Strongyloides stercoralis 2 (3%). The mean Plasmodium parasite density was significantly higher in malaria-STHs-coinfected patients than in patients infected with only Plasmodium parasite density was significantly higher in malaria-STHs-coinfected patients than in patients infected with only P value of <0.05 was considered as statistically significant. Plasmodium parasite density was significantly higher in malaria-STHs-coinfected patients than in patients infected with only F = 6.953, P value of <0.05 was considered as statistically significant. Conclusions Infections with STHs, especially hookworm, were positively associated with Plasmodium parasite density. The current study finding also revealed that increased worm burden of hookworm as expressed by egg intensity had significantly increased Plasmodium parasite density.Plasmodium parasite density was significantly higher in malaria-STHs-coinfected patients than in patients infected with only Plasmodium parasite density was significantly higher in malaria-STHs-coinfected patients than in patients infected with only.
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Tuasha N, Hailemeskel E, Erko B, Petros B. Comorbidity of intestinal helminthiases among malaria outpatients of Wondo Genet health centers, southern Ethiopia: implications for integrated control. BMC Infect Dis 2019; 19:659. [PMID: 31340774 PMCID: PMC6657167 DOI: 10.1186/s12879-019-4290-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
Background It is estimated that over a third of the world population is infected by malaria and helminthiases mainly among communities with high poverty indices. The distribution of these parasitic infections overlaps in many epidemiological settings and have varying outcomes in the host. In this paper we report the prevalence of malaria and intestinal helminthiases coinfections among malaria suspected patients and the association of helminthiases with the occurrence of malaria and its outcomes in Wondo Genet, southern Ethiopia. Methods In a cross-sectional study conducted from December 2009 to July 2010 in Kella, Aruma and Busa Health Centers in Wondo Genet, a total of 427 consenting febrile patients were screened for malaria and intestinal helminths infections. Malaria parasite detection and quantification were done using Giemsa stained thick and thin blood films. Helminth infections were screened and quantified by Kato-Katz thick smear method. Haemoglobin level was assessed using haemocue machine (HemoCue HB 201+). Difference in proportions and means were tested by Student’s t test and ANOVA while logistic regression analysis was used to determine the association between variables. Results Of the total examined, 196 (45.90%) were positive for at least one helminth infection while 276 (64.64%) were positive for malaria. The prevalence of Plasmodium falciparum and P. vivax infections were 47.31 and 16.62%, respectively. The most common helminth parasites detected were Ascaris lumbricoides (33.96%), Trichuris trichiura (21.55%), Schistosoma mansoni (13.35%), and hookworms (6.79%). The overall malaria-helminthiases coinfection was 33.96%. The prevalence of anaemia was 43.12%. Helminthiases coinfection showed a positive correlation with the occurrence of malaria (AOR = 2.17, 95% CI: 1.44–3.28; P < 0.001). Schistosoma mansoni coinfection was associated with the increased risk of developing malaria associated anaemia (OR = 14.4, 95% CI: 1.37–150.80; P = 0.026). Conclusion Malaria and helminth coinfections are important causes of morbidities among the population in Wondo Genet necessitating integrated control measures. Nevertheless, further detailed studies on the consequences and pathogenesis of these coinfections are needed to institute sound control and intervention measures.
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Affiliation(s)
- Nigatu Tuasha
- College of Natural and Computational Sciences, Mizan-Tepi University, P.O. Box 121, Tepi, Ethiopia. .,Department of Microbial, Cellular and Molecular Biology, College of Natural Sciences, Addis Ababa University, P. O. Box, 1176, Addis Ababa, Ethiopia.
| | - Elifaged Hailemeskel
- College of Natural and Computational Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia.,Department of Microbial, Cellular and Molecular Biology, College of Natural Sciences, Addis Ababa University, P. O. Box, 1176, Addis Ababa, Ethiopia
| | - Berhanu Erko
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P. O. Box, 1176, Addis Ababa, Ethiopia
| | - Beyene Petros
- Department of Microbial, Cellular and Molecular Biology, College of Natural Sciences, Addis Ababa University, P. O. Box, 1176, Addis Ababa, Ethiopia
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Dejon-Agobé JC, Zinsou JF, Honkpehedji YJ, Ateba-Ngoa U, Edoa JR, Adegbite BR, Mombo-Ngoma G, Agnandji ST, Ramharter M, Kremsner PG, Lell B, Grobusch MP, Adegnika AA. Schistosoma haematobium effects on Plasmodium falciparum infection modified by soil-transmitted helminths in school-age children living in rural areas of Gabon. PLoS Negl Trop Dis 2018; 12:e0006663. [PMID: 30080853 PMCID: PMC6095623 DOI: 10.1371/journal.pntd.0006663] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/16/2018] [Accepted: 07/05/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Malaria burden remains high in the sub-Saharan region where helminths are prevalent and where children are often infected with both types of parasites. Although the effect of helminths on malaria infection is evident, the impact of these co-infections is not clearly elucidated yet and the scarce findings are conflicting. In this study, we investigated the effect of schistosomiasis, considering soil-transmitted helminths (STH), on prevalence and incidence of Plasmodium falciparum infection. METHODOLOGY This longitudinal survey was conducted in school-age children living in two rural communities in the vicinity of Lambaréné, Gabon. Thick blood smear light microscopy, urine filtration and the Kato-Katz technique were performed to detect malaria parasites, S. haematobium eggs and, STH eggs, respectively. P. falciparum carriage was assessed at inclusion, and incidence of malaria and time to the first malaria event were recorded in correlation with Schistosoma carriage status. Stratified multivariate analysis using generalized linear model was used to assess the risk of plasmodium infection considering interaction with STH, and survival analysis to assess time to malaria. MAIN FINDINGS The overall prevalence on subject enrolment was 30%, 23% and 9% for S. haematobium, P. falciparum infections and co-infection with both parasites, respectively. Our results showed that schistosomiasis in children tends to increase the risk of plasmodium infection but a combined effect with Trichuris trichiura or hookworm infection clearly increase the risk (aOR = 3.9 [95%CI: 1.7-9.2]). The incidence of malaria over time was 0.51[95%CI: 0.45-0.57] per person-year and was higher in the Schistosoma-infected group compared to the non-infected group (0.61 vs 0.43, p = 0.02), with a significant delay of time-to first-malaria event only in children aged from 6 to 10-years-old infected with Schistosoma haematobium. CONCLUSIONS Our results suggest that STH enhance the risk for P. falciparum infection in schistosomiasis-positive children, and when infected, that schistosomiasis enhances susceptibility to developing malaria in young children but not in older children.
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Affiliation(s)
- Jean Claude Dejon-Agobé
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeannot Fréjus Zinsou
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yabo Josiane Honkpehedji
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ulysse Ateba-Ngoa
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Jean-Ronald Edoa
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Bayodé Roméo Adegbite
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Ghyslain Mombo-Ngoma
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
- Departement de Parasitologie-Mycologie, Faculté de Médecine, Université des Sciences de la Santé, Owendo, Gabon
| | - Selidji Todagbe Agnandji
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen and Partner site Tübingen, German Center for Infection Research, Tübingen, Germany
| | - Michael Ramharter
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I, Department of Medicine, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Gottfried Kremsner
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen and Partner site Tübingen, German Center for Infection Research, Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen and Partner site Tübingen, German Center for Infection Research, Tübingen, Germany
| | - Martin Peter Grobusch
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Institute of Tropical Medicine, University of Tübingen and Partner site Tübingen, German Center for Infection Research, Tübingen, Germany
| | - Ayôla Akim Adegnika
- Centre de Recherche Médicales de Lambaréné (CERMEL) and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
- Institute of Tropical Medicine, University of Tübingen and Partner site Tübingen, German Center for Infection Research, Tübingen, Germany
- * E-mail:
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The Impact of Artesunate-Amodiaquine on Schistosoma mansoni Infection among Children Infected by Plasmodium in Rural Area of Lemfu, Kongo Central, Democratic Republic of the Congo. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3487183. [PMID: 30112379 PMCID: PMC6077572 DOI: 10.1155/2018/3487183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/16/2018] [Accepted: 03/28/2018] [Indexed: 11/18/2022]
Abstract
Background Malaria and schistosomiasis remain life-threatening public health problems in sub-Saharan Africa. The infection pattern related to age indicates that preschool and school-age children are at the highest risk of malaria and schistosomiasis. Both parasitic infections, separately or combined, may have negative impacts on the haemoglobin concentration levels. The existing data revealed that artemisinin derivatives commonly used to cure malaria present also in antischistosomal activities. The current study investigated the impact of Artesunate-Amodiaquine (AS-AQ) on schistosomiasis when administered to treat malaria in rural area of Lemfu, DRC. Methodology A prospective longitudinal study including 171 coinfected children screened for anaemia, Schistosoma mansoni, and Plasmodium falciparum infections. The egg reduction rate and haemoglobin concentration were assessed four weeks after the treatment with AS-AQ, of all coinfected children of this series. Results One hundred and twenty-five (74.4%) out of 168 coinfected children treated and present during the assessment were found stool negative for S. mansoni eggs. Out of 43 (25.6%) children who remained positives, 37 (22%) showed a partial reduction of eggs amount, and no reduction was noted in 3.6% of coinfected. The mean of haemoglobin concentration and the prevalence of anaemia were, respectively, 10.74±1.5g/dl , 11.2±1.3g/dl, and 64.8%, 51.8%, respectively, before and after treatment, p<0.001. Conclusion The AS-AQ commonly used against Plasmodium allowed curing S. mansoni in coinfected children and increasing the Hb level. For the future, the randomized and multicentric clinical trials are needed for a better understanding of the effectiveness of AS-AQ against Schistosoma spp. The trial registration number was 3487183.
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Bwanika R, Kato CD, Welishe J, Mwandah DC. Cytokine profiles among patients co-infected with Plasmodium falciparum malaria and soil borne helminths attending Kampala International University Teaching Hospital, in Uganda. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2018; 14:10. [PMID: 29560020 PMCID: PMC5858126 DOI: 10.1186/s13223-018-0235-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/06/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Malaria and helminths share the same geographical distribution in tropical Africa. Studies of the interaction of helminth and malaria co-infection in humans have been few and are mainly epidemiological, with little information on cellular immune responses. This study aimed to determine Cytokine profiles among patients co-infected with Plasmodium falciparum malaria and soil borne helminth attending Kampala International University Teaching Hospital (KIU). METHODS A case control study of 240 patients were recruited at KIU teaching hospital. Patients with Plasmodium falciparum malaria were 55 (22.9%) and those with soil-borne helminths were 63 (26.3%). The controls were 89 (37.1%), while those co-infected with Plasmodium falciparum malaria and soil-borne helminths were 33 (13.8%). Cases were defined as having a positive blood smear for P. falciparum malaria, those with helminths or co-infections of the two. Negative controls were those with a negative blood smear for P. falciparum malaria and those with no stool parasitic infections. Patients presenting with signs and symptoms of malaria or those suspected of having helminths were recruited for the study. A panel of five cytokines (IFN-γ, TNF-α, IL-6, TGF-β and IL-10) were assayed from plasma samples in patients with and without Plasmodium falciparum malaria, patients with and without helminth, and then those co-infected with the two diseases diagnosis was done using thick blood smears stained with 10% Giemsa and stool examination was done following the Kato Katz technique following standard procedures. RESULTS The prevalence of Plasmodium falciparum malaria by sex was 28 (11.7%) and 27 (11.3%) in male and female respectively. The overall prevalence of soil borne helminth was 26.3%, and among those harbouring helminths, 13.8% were co-infected with Plasmodium falciparum. Cytokine levels significantly differed across Plasmodium falciparum malaria, soil borne helminth infected patients and health controls for IFN-γ (P = 0.023), IL-10 (P = 0.008) and TGF-β (P = 0.0001). Cytokine levels significantly differed across Plasmodium falciparum malaria, soil borne helminth infected patients and patients co-infected with Plasmodium falciparum malaria and soil borne helminth for IL-10 (P = 0.004), IL-6 (P = 0.011) and TGF-β (P = 0.003). CONCLUSION An up-regulation of IFN-γ during Plasmodium falciparum malaria and an up-regulation of IL-10 and TGF-β in soil borne helminth infections was demonstrated. We demonstrate that co-infections of Plasmodium falciparum and soil borne helminth lead to an up-regulation of IL-10 and IL-6 and a down-regulation of TGF-β.Trial registration No17/10-16.
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Affiliation(s)
- Richard Bwanika
- School of Biomedical Sciences, Department of Microbiology, Kampala International University, Western Campus, Ishaka, Box 71, Bushenyi, Uganda
| | - Charles D. Kato
- School of Biomedical Sciences, Department of Microbiology, Kampala International University, Western Campus, Ishaka, Box 71, Bushenyi, Uganda
- School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Johnson Welishe
- School of Biomedical Sciences, Department of Microbiology, Kampala International University, Western Campus, Ishaka, Box 71, Bushenyi, Uganda
- School of Bio-security, Biotechnical & Laboratory Sciences, College of Veterinary Medicine, Animal Resources & Bio-security, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Daniel C. Mwandah
- School of Biomedical Sciences, Department of Microbiology, Kampala International University, Western Campus, Ishaka, Box 71, Bushenyi, Uganda
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Abebe SM, Andargie G, Shimeka A, Alemu K, Kebede Y, Wubeshet M, Tariku A, Gebeyehu A, Bayisa M, Yitayal M, Awoke T, Azmeraw T, Birku M. The prevalence of non-communicable diseases in northwest Ethiopia: survey of Dabat Health and Demographic Surveillance System. BMJ Open 2017; 7:e015496. [PMID: 29061601 PMCID: PMC5665308 DOI: 10.1136/bmjopen-2016-015496] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The main objective of this study was to investigate the magnitude and associated factors of non-communicable chronic diseases (NCDs) at the Dabat Health and Demographic Surveillance System (DHDSS) site in the northwestern part of Ethiopia. DESIGN A population-based cross-sectional study was conducted from October to December 2014. SETTING HDSS site, Ethiopia. PARTICIPANTS A total population of 67 397 living in 16 053 households was included in the study. MEASURES Structured interviewer-administered questionnaire was used to collect data. Self-reported morbidity was used to ascertain NCD. A binary logistic regression model was employed to identify the determinants of NCDs. RESULT One thousand one hundred sixty (1.7%) (95% CI 1.62 to 1.82) participants were found with at least one type of NCD. Heart disease and hypertension which accounted for 404 (32.2%) and 401 (31.9%), of the burden, respectively, were the most commonly reported NCDs, followed by 347 (27.7%) asthma, 62 (4.9%) diabetes mellitus and 40 (3.2%) cancer cases. Advanced age (≥65 year) (adjusted OR (AOR)=19.6; 95% CI 5.83 65.70), urban residence (AOR=2.20; 95% CI 1.83 to 2.65), household food insecurity (AOR=1.71; 95% CI 1.37 to 2.12) and high income (AOR=1.28; 95% CI 1.02 to 1.59) were significantly associated with the reported history of NCDs, whereas low (AOR=0.36; 95% CI 0.31 to 0.42) and moderate (AOR=0.33; 95% CI 0.22 to 0.48) alcohol consumption, farming occupation (AOR=0.72; 95% CI 0.57 to 0.91), and work-related physical activities (AOR=0.66; 95% CI 0.50 to 0.88) were inversely associated with NCDs. CONCLUSION There is a high burden of NCDs at the Dabat HDSS site. Promotion of regular physical exercise and reducing alcohol consumption are essential to mitigate the burden of NCDs. In addition, preventive interventions of NCDs should be strengthened among urban dwellers, older age people and people of higher economic status.
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Affiliation(s)
- Solomon Mekonnen Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gashaw Andargie
- Department of Health Service Management and Health Economics, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemayehu Shimeka
- Department of Epidemiology and Biostatistics, Institute of Public Health College of Medicine and Health Sciences,University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health College of Medicine and Health Sciences,University of Gondar, Gondar, Ethiopia
| | - Yigzaw Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health College of Medicine and Health Sciences,University of Gondar, Gondar, Ethiopia
| | - Mamo Wubeshet
- Department of Environmental and Occupational Health and Safety, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Tariku
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebaw Gebeyehu
- Dabat Research Centre Health and Demographic Surveillance System, Institute of Public Health College of Medicine and Health Sciences,University of Gondar, Gondar, Ethiopia
| | - Mulugeta Bayisa
- Department of Epidemiology and Biostatistics, Institute of Public Health College of Medicine and Health Sciences,University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Service Management and Health Economics, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke
- Department of Epidemiology and Biostatistics, Institute of Public Health College of Medicine and Health Sciences,University of Gondar, Gondar, Ethiopia
| | - Temesgen Azmeraw
- Dabat Research Centre Health and Demographic Surveillance System, Institute of Public Health College of Medicine and Health Sciences,University of Gondar, Gondar, Ethiopia
| | - Melkamu Birku
- Dabat Research Centre Health and Demographic Surveillance System, Institute of Public Health College of Medicine and Health Sciences,University of Gondar, Gondar, Ethiopia
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abstract
Malaria is caused in humans by five species of single-celled eukaryotic Plasmodium parasites (mainly Plasmodium falciparum and Plasmodium vivax) that are transmitted by the bite of Anopheles spp. mosquitoes. Malaria remains one of the most serious infectious diseases; it threatens nearly half of the world's population and led to hundreds of thousands of deaths in 2015, predominantly among children in Africa. Malaria is managed through a combination of vector control approaches (such as insecticide spraying and the use of insecticide-treated bed nets) and drugs for both treatment and prevention. The widespread use of artemisinin-based combination therapies has contributed to substantial declines in the number of malaria-related deaths; however, the emergence of drug resistance threatens to reverse this progress. Advances in our understanding of the underlying molecular basis of pathogenesis have fuelled the development of new diagnostics, drugs and insecticides. Several new combination therapies are in clinical development that have efficacy against drug-resistant parasites and the potential to be used in single-dose regimens to improve compliance. This ambitious programme to eliminate malaria also includes new approaches that could yield malaria vaccines or novel vector control strategies. However, despite these achievements, a well-coordinated global effort on multiple fronts is needed if malaria elimination is to be achieved.
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Affiliation(s)
- Margaret A Phillips
- Department of Biochemistry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9038, USA
| | | | | | | | - Wesley C Van Voorhis
- University of Washington, Department of Medicine, Division of Allergy and Infectious Diseases, Center for Emerging and Re-emerging Infectious Diseases, Seattle, Washington, USA
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Concomitant helminth infection downmodulates the Vaccinia virus-specific immune response and potentiates virus-associated pathology. Int J Parasitol 2016; 47:1-10. [PMID: 28003150 DOI: 10.1016/j.ijpara.2016.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/29/2016] [Accepted: 08/31/2016] [Indexed: 12/16/2022]
Abstract
The aim of this work was to elucidate the immunopathological mechanisms of how helminths may influence the course of a viral infection, using a murine model. Severe virulence, a relevant increase in the virus titres in the lung and a higher mortality rate were observed in Ascaris and Vaccinia virus (VACV) co-infected mice, compared with VACV mono-infected mice. Immunopathological analysis suggested that the ablation of CD8+ T cells, the marked reduction of circulating CD4+ T cells producing IFN-γ, and the robust pulmonary inflammation were associated with the increase of morbidity/mortality in co-infection and subsequently with the negative impact of concomitant pulmonary ascariasis and respiratory VACV infection for the host. On the other hand, when evaluating the impact of the co-infection on the parasitic burden, co-infected mice presented a marked decrease in the total number of migrating Ascaris lung-stage larvae in comparison with Ascaris mono-infection. Taken together, our major findings suggest that Ascaris and VACV co-infection may potentiate the virus-associated pathology by the downmodulation of the VACV-specific immune response. Moreover, this study provides new evidence of how helminth parasites may influence the course of a coincident viral infection.
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Immune Profile of Honduran Schoolchildren with Intestinal Parasites: The Skewed Response against Geohelminths. J Parasitol Res 2016; 2016:1769585. [PMID: 27882241 PMCID: PMC5108857 DOI: 10.1155/2016/1769585] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/10/2016] [Indexed: 01/18/2023] Open
Abstract
Soil-transmitted helminth infections typically induce a type-2 immune response (Th2), but no immunoepidemiological studies have been undertaken in Honduras, an endemic country where the main control strategy is children's annual deworming. We aimed to characterize the immune profile of Honduran schoolchildren harbouring these parasitoses. Demographic and epidemiological data were obtained through a survey; nutritional status was assessed through anthropometry; intestinal parasites were diagnosed by formol-ether and Kato-Katz; and blood samples were collected to determine immunological markers including Th1/Th2 cytokines, IgE, and eosinophil levels. A total of 225 children participated in the study, all of whom had received deworming during the national campaign five months prior to the study. Trichuriasis and ascariasis prevalence were 22.2% and 20.4%, respectively. Stunting was associated with both age and trichuriasis, whereas ascariasis was associated with sex and household conditions. Helminth infections were strongly associated with eosinophilia and hyper-IgE as well as with a Th2-polarized response (increased levels of IL-13, IL-10, and IL4/IFN-γ ratios and decreased levels of IFN-γ). Pathogenic protozoa infections were associated with a Th1 response characterized by elevated levels of IFN-γ and decreased IL10/IFN-γ ratios. Even at low prevalence levels, STH infections affect children's nutrition and play a polarizing role in their immune system.
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Ateba-Ngoa U, Jones S, Zinsou JF, Honkpehedji J, Adegnika AA, Agobe JCD, Massinga-Loembe M, Mordmüller B, Bousema T, Yazdanbakhsh M. Associations Between Helminth Infections, Plasmodium falciparum Parasite Carriage and Antibody Responses to Sexual and Asexual Stage Malarial Antigens. Am J Trop Med Hyg 2016; 95:394-400. [PMID: 27273645 DOI: 10.4269/ajtmh.15-0703] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/28/2015] [Indexed: 12/28/2022] Open
Abstract
Infections with helminths and Plasmodium spp. overlap in their geographical distribution. It has been postulated that helminth infections may influence malarial transmission by altering Plasmodium falciparum gametocytogenesis. This cross-sectional study assessed the effect of helminth infections on P. falciparum gametocyte carriage and on humoral immune responses to sexual stage antigens in Gabon. Schistosoma haematobium and filarial infections as well as P. falciparum asexual forms and gametocyte carriage were determined. The antibody responses measured were to sexual (Pfs230, Pfs48/45) and asexual P. falciparum antigens (AMA1, MSP1, and GLURP). A total of 287 subjects were included. The prevalence of microscopically detectable P. falciparum asexual parasites was higher in S. haematobium-infected subjects in comparison to their uninfected counterparts (47% versus 26%, P = 0.003), but this was not different when filarial infections were considered. Plasmodium falciparum gametocyte carriage was similar between Schistosoma- or filaria-infected and uninfected subjects. We observed a significant decrease of Pfs48/45 immunoglobulin G titer in S. haematobium-infected subjects (P = 0.037), whereas no difference was seen for Pfs230 antibody titer, nor for antibodies to AMA1, MSP1, or GLURP. Our findings suggest an effect of S. haematobium on antibody responses to some P. falciparum gametocyte antigens that may have consequences for transmission-blocking immunity.
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Affiliation(s)
- Ulysse Ateba-Ngoa
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands. Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany. Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.
| | - Sophie Jones
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeannot Fréjus Zinsou
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany. Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Josiane Honkpehedji
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany. Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Ayola Akim Adegnika
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands. Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany. Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Jean-Claude Dejon Agobe
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany. Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Marguerite Massinga-Loembe
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany. Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Benjamin Mordmüller
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany. Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Teun Bousema
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom. Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
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Njua-Yafi C, Achidi EA, Anchang-Kimbi JK, Apinjoh TO, Mugri RN, Chi HF, Tata RB, Njumkeng C, Nkock EN, Nkuo-Akenji T. Malaria, helminths, co-infection and anaemia in a cohort of children from Mutengene, south western Cameroon. Malar J 2016; 15:69. [PMID: 26852392 PMCID: PMC4744422 DOI: 10.1186/s12936-016-1111-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 01/18/2016] [Indexed: 12/20/2022] Open
Abstract
Background Malaria and helminthiases frequently co-infect the same individuals in endemic zones. Plasmodium falciparum and helminth infections have long been recognized as major contributors to anaemia in endemic countries. Several studies have explored the influence of helminth infections on the course of malaria in humans but how these parasites interact within co-infected individuals remains controversial. Methods In a community-based longitudinal study from March 2011 to February 2012, the clinical and malaria parasitaemia status of a cohort of 357 children aged 6 months to 10 years living in Mutengene, south-western region of Cameroon, was monitored. Following the determination of baseline malaria/helminths status and haemoglobin levels, the incidence of malaria and anaemia status was determined in a 12 months longitudinal study by both active and passive case detection. Results Among all the children who completed the study, 32.5 % (116/357) of them had at least one malaria episode. The mean (±SEM) number of malaria attacks per year was 1.44 ± 0.062 (range: 1–4 episodes) with the highest incidence of episodes occuring during the rainy season months of March–October. Children <5 years old were exposed to more malaria attacks [OR = 2.34, 95 % CI (1.15–4.75), p = 0.019] and were also more susceptible to anaemia [OR = 2.24, 95 % CI (1.85–4.23), p = 0.013] compared to older children (5–10 years old). Likewise children with malaria episodes [OR = 4.45, 95 % CI (1.66–11.94), p = 0.003] as well as those with asymptomatic parasitaemia [OR = 2.41, 95 % CI (1.58–3.69) p < 0.001] were susceptible to anaemia compared to their malaria parasitaemia negative counterparts. Considering children infected with Plasmodium alone as the reference, children infected with helminths alone were associated with protection from anaemia [OR = 0.357, 95 % CI (0.141–0.901), p = 0.029]. The mean haemoglobin level (g/dl) of participants co-infected with Plasmodium and helminths was higher (p = 0.006) compared to participants infected with Plasmodium or helminths alone. Conclusion Children below 5 years of age were more susceptible to malaria and anaemia. The high prevalence of anaemia in this community was largely due to malaria parasitaemia. Malaria and helminths co-infection was protective against anaemia. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1111-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clarisse Njua-Yafi
- Department of Animal Biology and Physiology, University of Yaounde I, Yaounde, Cameroon. .,Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
| | - Eric A Achidi
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon.
| | | | - Tobias O Apinjoh
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon.
| | - Regina N Mugri
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
| | - Hanesh F Chi
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
| | - Rolland B Tata
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
| | - Charles Njumkeng
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
| | - Emmanuel N Nkock
- Department of Medical Laboratory Science, University of Buea, Buea, Cameroon.
| | - Theresa Nkuo-Akenji
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
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Kraemer MUG, Hay SI, Pigott DM, Smith DL, Wint GRW, Golding N. Progress and Challenges in Infectious Disease Cartography. Trends Parasitol 2015; 32:19-29. [PMID: 26604163 DOI: 10.1016/j.pt.2015.09.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/30/2015] [Accepted: 09/17/2015] [Indexed: 02/02/2023]
Abstract
Quantitatively mapping the spatial distributions of infectious diseases is key to both investigating their epidemiology and identifying populations at risk of infection. Important advances in data quality and methodologies have allowed for better investigation of disease risk and its association with environmental factors. However, incorporating dynamic human behavioural processes in disease mapping remains challenging. For example, connectivity among human populations, a key driver of pathogen dispersal, has increased sharply over the past century, along with the availability of data derived from mobile phones and other dynamic data sources. Future work must be targeted towards the rapid updating and dissemination of appropriately designed disease maps to guide the public health community in reducing the global burden of infectious disease.
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Affiliation(s)
- Moritz U G Kraemer
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK.
| | - Simon I Hay
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-2220, USA
| | - David M Pigott
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - David L Smith
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-2220, USA; Sanaria Institute for Global Health and Tropical Medicine, Rockville, MD 20850, USA
| | - G R William Wint
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK; Environmental Research Group Oxford (ERGO), Department of Zoology, University of Oxford, Oxford, OX1 3PS, UK
| | - Nick Golding
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
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Getie S, Wondimeneh Y, Getnet G, Workineh M, Worku L, Kassu A, Moges B. Prevalence and clinical correlates of Schistosoma mansoni co-infection among malaria infected patients, Northwest Ethiopia. BMC Res Notes 2015; 8:480. [PMID: 26415939 PMCID: PMC4585811 DOI: 10.1186/s13104-015-1468-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Ethiopia, where malaria and schistosomiasis are co-endemic, co-infections are expected to be high. However, data about the prevalence of malaria-schistosomiasis co-infection and their clinical correlation is lacking. Therefore, the aim of this study was to assess prevalence of Schistosoma mansoni co-infection and associated clinical correlates in malaria patients. METHODS A cross-sectional study was conducted in 2013 at Chwahit Health Center, in northwest Ethiopia. Blood film positive malaria patients (N = 205) were recruited for the study. Clinical, parasitological, hematological, and biochemical parameters were assessed from every study participant. Stool samples were also collected and processed with Kato-Katz technique to diagnose and classify intensity of Schistosoma mansoni. RESULTS The prevalence of Schistosoma mansoni and malaria co-infection was 19.5%. The age group of 16-20 years old was significantly associated with co-infection. Co-infected patients with a moderate-heavy egg burden of Schistosoma mansoni had significantly high mean Plasmodium parasitemia. On the other hand, age group of 6-10 years old and moderate-heavy Schistosoma mansoni co-infection were significantly associated with severe malaria. CONCLUSIONS Prevalence of malaria and Schistosoma mansoni co-infection in the study area was considerably high. Severity of malaria and parasitemia of Plasmodium were associated with certain age groups and intensity of concurrent Schistosoma mansoni. Further study is needed to explore the underlying mechanisms of interaction between malaria and Schistosoma mansoni.
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Affiliation(s)
- Sisay Getie
- Department of Medical Parasitology, School of Medicine and Health Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Yitayih Wondimeneh
- Department of Medical Parasitology, School of Medicine and Health Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Gebeyaw Getnet
- Department of Medical Parasitology, School of Medicine and Health Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Meseret Workineh
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Ligabaw Worku
- Department of Medical Parasitology, School of Medicine and Health Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Afework Kassu
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Beyene Moges
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Onkoba NW, Chimbari MJ, Mukaratirwa S. Malaria endemicity and co-infection with tissue-dwelling parasites in Sub-Saharan Africa: a review. Infect Dis Poverty 2015; 4:35. [PMID: 26377900 PMCID: PMC4571070 DOI: 10.1186/s40249-015-0070-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/03/2015] [Indexed: 02/08/2023] Open
Abstract
Mechanisms and outcomes of host-parasite interactions during malaria co-infections with gastrointestinal helminths are reasonably understood. In contrast, very little is known about such mechanisms in cases of malaria co-infections with tissue-dwelling parasites. This is lack of knowledge is exacerbated by misdiagnosis, lack of pathognomonic clinical signs and the chronic nature of tissue-dwelling helminthic infections. A good understanding of the implications of tissue-dwelling parasitic co-infections with malaria will contribute towards the improvement of the control and management of such co-infections in endemic areas. This review summarises and discusses current information available and gaps in research on malaria co-infection with gastro-intestinal helminths and tissue-dwelling parasites with emphasis on helminthic infections, in terms of the effects of migrating larval stages and intra and extracellular localisations of protozoan parasites and helminths in organs, tissues, and vascular and lymphatic circulations.
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Affiliation(s)
- Nyamongo W Onkoba
- College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Howard Campus, Durban, South Africa.
- Departmet of Tropical Infectious Diseases, Institute of Primate Research, Karen, Nairobi, Kenya.
| | - Moses J Chimbari
- College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Howard Campus, Durban, South Africa.
| | - Samson Mukaratirwa
- School of Life Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa.
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Coomes SM, Pelly VS, Kannan Y, Okoye IS, Czieso S, Entwistle LJ, Perez-Lloret J, Nikolov N, Potocnik AJ, Biró J, Langhorne J, Wilson MS. IFNγ and IL-12 Restrict Th2 Responses during Helminth/Plasmodium Co-Infection and Promote IFNγ from Th2 Cells. PLoS Pathog 2015; 11:e1004994. [PMID: 26147567 PMCID: PMC4493106 DOI: 10.1371/journal.ppat.1004994] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 06/02/2015] [Indexed: 12/19/2022] Open
Abstract
Parasitic helminths establish chronic infections in mammalian hosts. Helminth/Plasmodium co-infections occur frequently in endemic areas. However, it is unclear whether Plasmodium infections compromise anti-helminth immunity, contributing to the chronicity of infection. Immunity to Plasmodium or helminths requires divergent CD4+ T cell-driven responses, dominated by IFNγ or IL-4, respectively. Recent literature has indicated that Th cells, including Th2 cells, have phenotypic plasticity with the ability to produce non-lineage associated cytokines. Whether such plasticity occurs during co-infection is unclear. In this study, we observed reduced anti-helminth Th2 cell responses and compromised anti-helminth immunity during Heligmosomoides polygyrus and Plasmodium chabaudi co-infection. Using newly established triple cytokine reporter mice (Il4gfpIfngyfpIl17aFP635), we demonstrated that Il4gfp+ Th2 cells purified from in vitro cultures or isolated ex vivo from helminth-infected mice up-regulated IFNγ following adoptive transfer into Rag1–/– mice infected with P. chabaudi. Functionally, Th2 cells that up-regulated IFNγ were transcriptionally re-wired and protected recipient mice from high parasitemia. Mechanistically, TCR stimulation and responsiveness to IL-12 and IFNγ, but not type I IFN, was required for optimal IFNγ production by Th2 cells. Finally, blockade of IL-12 and IFNγ during co-infection partially preserved anti-helminth Th2 responses. In summary, this study demonstrates that Th2 cells retain substantial plasticity with the ability to produce IFNγ during Plasmodium infection. Consequently, co-infection with Plasmodium spp. may contribute to the chronicity of helminth infection by reducing anti-helminth Th2 cells and converting them into IFNγ-secreting cells. Approximately a third of the world’s population is burdened with chronic intestinal parasitic helminth infections, causing significant morbidities. Identifying the factors that contribute to the chronicity of infection is therefore essential. Co-infection with other pathogens, which is extremely common in helminth endemic areas, may contribute to the chronicity of helminth infections. In this study, we used a mouse model to test whether the immune responses to an intestinal helminth were impaired following malaria co-infection. These two pathogens induce very different immune responses, which, until recently, were thought to be opposing and non-interchangeable. This study identified that the immune cells required for anti-helminth responses are capable of changing their phenotype and providing protection against malaria. By identifying and blocking the factors that drive this change in phenotype, we can preserve anti-helminth immune responses during co-infection. Our studies provide fresh insight into how immune responses are altered during helminth and malaria co-infection.
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Affiliation(s)
- Stephanie M. Coomes
- Division of Molecular Immunology, The Francis Crick Institute, London, United Kingdom
| | - Victoria S. Pelly
- Division of Molecular Immunology, The Francis Crick Institute, London, United Kingdom
| | - Yashaswini Kannan
- Division of Molecular Immunology, The Francis Crick Institute, London, United Kingdom
| | - Isobel S. Okoye
- Division of Molecular Immunology, The Francis Crick Institute, London, United Kingdom
| | - Stephanie Czieso
- Division of Molecular Immunology, The Francis Crick Institute, London, United Kingdom
| | - Lewis J. Entwistle
- Division of Molecular Immunology, The Francis Crick Institute, London, United Kingdom
| | - Jimena Perez-Lloret
- Division of Molecular Immunology, The Francis Crick Institute, London, United Kingdom
| | - Nikolay Nikolov
- Division of Systems Biology, The Francis Crick Institute, London, United Kingdom
| | - Alexandre J. Potocnik
- Division of Molecular Immunology, The Francis Crick Institute, London, United Kingdom
| | - Judit Biró
- Division of Molecular Immunology, The Francis Crick Institute, London, United Kingdom
| | - Jean Langhorne
- Division of Parasitology, Mill Hill Laboratories, London, United Kingdom
| | - Mark S. Wilson
- Division of Molecular Immunology, The Francis Crick Institute, London, United Kingdom
- * E-mail:
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Akuffo H, Britton S, Schön T. Worms and Humans: A Happy Divorce? FORUM ON IMMUNOPATHOLOGICAL DISEASES AND THERAPEUTICS 2015; 6:27-32. [PMID: 28392966 PMCID: PMC5381959 DOI: 10.1615/forumimmundisther.2015015300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic asymptomatic worm infection, often in combination with tuberculosis (TB), is common in low-income countries. Indeed, a life without worm infestation, as is now the case in most high-income countries, is a recent condition for humankind. Worms and Mycobacterium tuberculosis give rise to different immune response patterns (Th2 vs. Th1 driven), and we have studied whether chronic worm infection affects the susceptibility to and control of TB in the low income country of Ethiopia. Our results, as well of those in the general literature, are inconclusive, although we have some rather strong data in support of adult deworming in relation to vaccination with bacillus Calmette-Guérin (BCG) against TB. In addition, we discuss briefly the putative relationship between chronic worm infestation and autoimmunity/allergy.
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Affiliation(s)
- Hannah Akuffo
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Britton
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Schön
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Mulu A, Kassu A, Legesse M, Erko B, Nigussie D, Shimelis T, Belyhun Y, Moges B, Ota F, Elias D. Helminths and malaria co-infections are associated with elevated serum IgE. Parasit Vectors 2014; 7:240. [PMID: 24886689 PMCID: PMC4063426 DOI: 10.1186/1756-3305-7-240] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/19/2014] [Indexed: 02/05/2023] Open
Abstract
Background Both helminth and malaria infections result in a highly polarized immune response characterized by IgE production. This study aimed to investigate the total serum IgE profile in vivo as a measure of Th2 immune response in malaria patients with and without helminth co-infection. Methods A cross sectional observational study composed of microscopically confirmed malaria positive (N = 197) and malaria negative (N = 216) apparently healthy controls with and without helminth infection was conducted at Wondo Genet Health Center, Southern Ethiopia. A pre-designed structured format was utilized to collect socio-demographic and clinical data of the subjects. Detection and quantification of helminths, malaria parasites and determination of serum IgE levels were carried out following standard procedures. Results Irrespective of helminth infection, individuals infected by malaria showed significantly high levels of serum IgE compared with malaria free apparently healthy controls (with and without helminth infections). Moreover, malaria patients co-infected with intestinal helminths showed high level of serum IgE compared with those malaria patients without intestinal helminths (2198 IU/ml versus 1668 IU/ml). A strong statistically significant association was observed between malaria parasite density and elevated serum IgE levels (2047 IU/ml versus 1778 IU/ml; P = 0.001) with high and low parasitaemia (parasite density >50,000 parasite/μl of blood), respectively. Likewise, helminth egg loads were significantly associated with elevated serum IgE levels (P = 0.003). Conclusions The elevated serum IgE response in malaria patients irrespective of helminth infection and its correlation with malaria parasite density and helminth egg intensity support that malaria infection is also a strong driver of IgE production as compared to helminths.
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Affiliation(s)
- Andargachew Mulu
- Department of Microbiology, College of Medicine, University of Gondar, Gondar, Ethiopia.
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Helpful or a Hindrance: Co-infections with Helminths During Malaria. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 828:99-129. [DOI: 10.1007/978-1-4939-1489-0_5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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