Malaria and related outcomes in patients with intestinal helminths: a cross-sectional study
Malaria and related outcomes in patients with intestinal helminths: a cross-sectional study
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DOI：
10.1186/1471-2334-12-291
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发表时间：
2012-11-09
影响因子：
3.7
通讯作者：
Erko, Berhanu
中科院分区：
文献类型：
--
作者：
Degarege, Abraham;Legesse, Mengistu;Erko, Berhanu
背景：寄生虫合并感染对人类疟疾的影响尚不确定。本研究旨在评估肠道蠕虫与疟原虫感染的患病率和临床结果的关系。方法：2010年12月至2011年2月，对埃塞俄比亚南部多雷巴菲诺卫生中心1065例疟疾疑似发热患者进行横断面研究。分别用吉氏染色血片和Kato-Katz技术诊断寄生虫感染和肠蠕虫感染。血红蛋白水平用血液仪测定。结果：1065例疟疾疑似发热患者中，疟原虫阳性检出率为28.8%，其中恶性疟原虫占13.0%，间日疟原虫占14.5%，恶性疟原虫和间日疟原虫分别占1.3%。在702例提供粪便样本的患者中，肠道蠕虫、单独疟原虫和同时感染疟原虫和肠道蠕虫的比例分别为53.8%、31.6%和19.4%。其中，类蚓蛔虫感染率为35.9%，毛滴虫感染率为15.8%，曼氏血吸虫感染率为11.7%，钩虫感染率为9.8%。222例（31.6%）疟原虫感染病例中，9例（4.1%）为重度疟疾。与未感染肠道蠕虫的发热患者（9.3%）相比，单独感染蛔虫（21.3%）、单独感染毛螺旋体（23.1%）和单独感染曼氏梭菌（23.1%）的发热患者更常见（p < 0.001）。肠道蠕虫感染个体的非严重疟疾患病率显著高于未感染肠道蠕虫的个体（校正OR = 1.58, 95% CI = 1.13-2.22）。单独感染蚓状拟虫、毛毛拟虫和曼森拟虫的个体发生非严重恶性疟原虫疟疾的几率分别是未感染肠道寄生虫个体的2.6倍、2.8倍和3.3倍（p < 0.05）。感染非严重恶性疟原虫的优势比随着肠道寄生虫种类的增加而增加（p < 0.001）。肠道蠕虫感染个体的平均疟原虫密度随肠道蠕虫种数的增加而显著增加（p = 0.027）。与仅感染疟原虫的个体相比，同时感染不同种类肠道蠕虫和疟原虫的个体血红蛋白平均浓度较低。结论：蚓状拟虫、毛毛拟虫和曼氏拟虫感染与恶性疟原虫感染呈正相关。然而，需要进一步的研究来调查这些寄生虫是如何导致恶性疟原虫感染流行率增加的。
Background: The effects of helminth co-infection on malaria in humans remain uncertain. This study aimed to evaluate the nature of association of intestinal helminths with prevalence and clinical outcomes of Plasmodium infection.Methods: A cross-sectional study involving 1,065 malaria suspected febrile patients was conducted at Dore Bafeno Health Center, Southern Ethiopia, from December 2010 to February 2011. Plasmodium and intestinal helminth infections were diagnosed using Giemsa-stained blood films and Kato-Katz technique, respectively. Haemoglobin level was determined using a haemocue machine.Results: Among 1,065 malaria suspected febrile patients, 28.8% were positive for Plasmodium parasites (P. falciparum = 13.0%, P. vivax = 14.5%, P. falciparum and P. vivax = 1.3%). Among 702 patients who provided stool samples, 53.8%, 31.6% and 19.4% were infected with intestinal helminths, Plasmodium alone and with both Plasmodium and intestinal helminths, respectively. The prevalence of infections with Ascaris lumbricoides (A. lumbricoides), Trichuris trichiura (T. trichiura), Schistosoma mansoni (S. mansoni) and hookworm (9.8%) were 35.9%, 15.8%, 11.7% and 9.8%, respectively. Out of the 222 (31.6%) Plasmodium infected cases, 9 (4.1%) had severe malaria. P. falciparum infection was more common in febrile patients infected with A. lumbricoides alone (21.3%), T. trichiura alone (23.1%) and S. mansoni alone (23.1%) compared to those without intestinal helminth infections (9.3%) (p < 0.001 for all). Prevalence of non-severe malaria was significantly higher in individuals infected with intestinal helminths than in those who were not infected with intestinal helminths (adjusted OR = 1.58, 95% CI = 1.13-2.22). The chance of developing non-severe P. falciparum malaria were 2.6, 2.8 and 3.3 times higher in individuals infected with A. lumbricoides alone, T. trichiura alone and S. mansoni alone, respectively, compared to intestinal helminth-free individuals (p < 0.05 for all). The odds ratio for being infected with non-severe P. falciparum increased with the number of intestinal helminth species (p < 0.001). Mean Plasmodium density among intestinal helminth infected individuals was significantly increased with the number of intestinal helminths species (p = 0.027). Individuals who were co-infected with different species of intestinal helminths and Plasmodium showed lower mean haemoglobin concentration than individuals who were infected only with Plasmodium.Conclusions: Infections with A. lumbricoides, T. trichiura and S. mansoni were positively associated with P. falciparum infection. However, further studies are required to investigate how these helminths could contribute to increased prevalence of P. falciparum infection.