Malaria severity status in patients with soil-transmitted helminth infections
Introduction
Malaria is widely co-endemic with intestinal helminth infections such as hookworm infections, ascariasis, trichuriasis and schistosomiasis, resulting in a high rate of co-infection (Adrienne et al., 2005, Brooker et al., 2006). Studies on malaria and helminth co-infections have shown contradictory results regarding severity of malaria. Infection with Ascaris lumbricoides was reported to suppress malaria symptoms including cerebral malaria (Nacher et al., 2000). The association was reported to hold true for all helminths in protecting from cerebral malaria, renal failure, jaundice and higher body temperature (Nacher et al., 2001a, Nacher et al., 2001b, Nacher et al., 2002a). Furthermore, the treatment of ascariasis has been shown to be accompanied by recrudescence of malaria attacks (Murray et al., 1978).
On the other hand, soil-transmitted helminths and Schistosoma mansoni are reported to increase the incidence of clinical malaria in children (Spigel et al., 2003, Hartgers and Yazdanbakhsh, 2006). LeHesran et al. (2004) have also shown the association between severe malaria attack and high prevalence of A. lumbricoides infection in children. Children infected either with intestinal helminths or S. haematobium are said to be more susceptible to acute malaria attacks (Jambou et al., 1998, Sokhna et al., 2004). An increased likelihood of falciparum malaria was also observed in patients with helminths in a low-transmission area (Nacher et al., 2002b). The present study was, therefore, undertaken to look at the possible impact of helminth infection on malaria severity, level of parasitaemia and clearance/reduction of Plasmodium parasites following treatment with anti-malarial drugs in Alaba Kulito, one of the malarious areas in Ethiopia.
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Study area and population
The study was conducted at Alaba Kulito Health Center in Alaba Woreda (administrative unit), south Ethiopia, located 313 km to the south of Addis Ababa. The Woreda is semi-arid with annual temperature ranging from 18 to 23 °C and mean annual rainfall from 100 to 120 mm. Malaria and intestinal parasites are the most prevalent public health problems in the area.
The study subjects included acute febrile patients who visited the Health Center in November and December 2007 and who presented with
Malaria infection and severity
Among 1802 patients who visited Alaba Kulito Health Center, south Ethiopia, in November and December 2007, 502 (27.9%) were found positive for Plasmodium parasites and 458 subjects (233 males and 225 females) fulfilled the inclusion criteria and enrolled in the study (Table 1). The highest malaria cases were due to P. vivax (79.9%) followed by P. falciparum (15.7%). Mixed infections with P. falciparum and P. vivax were detected in 4.4% of the cases. Highest prevalence of malaria (39.2%) was
Discussion
The present study showed that only few cases of helminth and malaria co-infected patients showed signs and symptoms of severe malaria as compared with severe manifestation in patients infected with malaria parasite alone. This indicates that helminth infection provides some degree of protection against the development of severe malaria which is also in agreement with the previous reports (Nacher et al., 2000, Nacher et al., 2001a, Nacher et al., 2002a)
Light infection with A. lumbricoides was
Acknowledgements
We thank the Global Fund Programme for Malaria and Aklilu Lemma Institute of Pathobiology for financial support of the work. We are also very much indebted to Ms Kokebe Gebere-Michael, Mr Sisay Dessie and all staff of the Alaba Kulito Health Center for their technical support and laboratory facilities. We also express our gratitude to the patients who voluntarily participated in the study.
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