Concurrent giardiasis and amoebiasis infections in Nigerian children diagnosed with Plasmodium falciparum malaria: prevalence and pathophysiological implications.

Bennett C. Nwanguma; Eddy O. Alumanah

摘要

The prevalence of giardiasis and amoebiasis as concurrent infections in Nigerian children diagnosed with Plasmodium falciparum malaria was investigated. From the results, 69 (27.6%) of the 250 children diagnosed with malaria, were concurrently infected by amoebiasis, 13 (5.20%) were infected by giardiasis, while 38 (15.2%) were infected by both giardiasis and amoebiasis. In all, 119 (47.60%) of the test population were concurrently infected by either one or both protozoan infections. The prevalence of giardiasis and mixed giardiasis/amoebiasis infections was significantly (p<.05) higher in the malaria-positive subjects than in the malaria-free group. However, the prevalence of amoebiasis in the malaria-positive group (27.6%) was lower than the prevalence (37.14%) in the malaria-negative control. It is concluded that a relatively high percentage of cases of childhood malaria in Nigeria is confounded by giardiasis and amoebiasis with severe implications for severity, duration and eventual outcome of illness. Introduction Complicated childhood malaria, which remains a major cause of infant morbidity and mortality in the malaria endemic countries of the tropics(1), is associated with a number of metabolic and pathophysiological disorders including, anaemia, hypovolaemia, metabolic acidosis, hypoglycaemia, respiratory distress and a variety of neurological features, all of which contribute to the often undesirable outcome of malaria episodes in children(2, , 3, 4, 5, 6).Contrary to the impression given by many studies on malaria (especially with laboratory-induced malaria), the prevailing climatic and socioeconomic conditions in the malaria - endemic countries of the tropics predispose affected populations to a number of other protozoan, bacterial and helminthic infections, which often confound episodes of malaria in these regions(7,8). When these diseases occur concurrently with malaria they have the ability to interfere with the immune responses to malaria(9, 10) and could also initiate (or aggravate) some of the life-threatening metabolic and pathophysiological disorders observed in childhood malaria. Thus, the severity, duration and eventual outcome of malaria episodes in children may depend on the absence or presence of these concurrent infections. However, these infections are usually ignored during diagnosis and treatment of malaria both during home management and in clinical settings.Children are often more vulnerable to these infections because they have a comparatively poorly developed immune system, which may not be sufficiently exposed to these infections to acquire the additional capability that sometimes renders the immune systems of adults impervious to these infections. In addition, children have a uniquely delicate physiology that increases their susceptibility to the life-threatening metabolic and pathophysiological disturbances and disorders associated with these infections.In our opinion, the likely presence of these concurrent infections is one of the major causes of the rapid debilitation, symptom aggravation and delayed recovery typical of malaria episodes in children. Thus, the concomitant presence of these often neglected infections could contribute significantly to why malaria remains a major threat to the survival of young children in many endemic countries of the tropics, where annual deaths due to malaria have remained unacceptably high despite the availability of a wide range of relatively effective preventive, prophylactic and therapeutic options (11, 12). There is need, therefore, to highlight the prevalence and possible pathophysiological implications of these concurrent infections in different populations of children as part of efforts to understand the complicated nature and unexpected outcomes of some episodes of childhood malaria. In this study, stool samples from children presenting with signs of illness suspected to be due to malaria were examined for the presence of two protozoan parasites na

机译：在诊断为恶性疟原虫疟疾的尼日利亚儿童中，贾第鞭毛虫病和阿米巴虫病并发感染的患病率进行了调查。结果表明，在250例被诊断出患有疟疾的儿童中，阿米巴病同时感染了69名（27.6％），贾第鞭毛虫同时感染了13名（5.20％），贾第鞭毛虫和阿米巴病同时感染了38名（15.2％）。总共有119位（47.60％）的测试人群同时被一种或两种原生动物感染同时感染。疟疾阳性受试者的贾第鞭毛虫病和贾第鞭毛虫/阿米巴虫病混合感染的发生率显着高于无疟疾组（p <.05）。但是，疟疾阳性组中阿米巴病的患病率（27.6％）低于疟疾阴性对照组中阿米巴病的患病率（37.14％）。结论是，尼日利亚相对较高的儿童疟疾病例是由贾第鞭毛虫病和阿米巴病混为一谈，严重影响了疾病的严重程度，持续时间和最终结果。引言复杂的儿童疟疾仍然是热带地区疟疾流行国家婴儿发病率和死亡率的主要原因（1），与许多代谢和病理生理疾病有关，包括贫血，低血容量，代谢性酸中毒，低血糖，呼吸窘迫以及多种神经系统特征，所有这些特征通常导致儿童疟疾发作通常令人不快的结果（2，，3、4、5、6）。与许多关于疟疾的研究给人的印象相反（特别是由实验室诱发的疟疾），热带地区流行的疟疾流行国家的气候和社会经济状况使受感染的人群易患许多其他原生动物，细菌和蠕虫感染，这些感染常常使这些地区的疟疾发作复杂化（7,8）。当这些疾病与疟疾同时发生时，它们具有干扰针对疟疾的免疫反应的能力（9、10），并且还可能引发（或加重）在儿童期疟疾中观察到的某些危及生命的代谢和病理生理疾病。因此，儿童疟疾发作的严重程度，持续时间和最终结果可能取决于这些并发感染的存在与否。然而，在家庭管理和临床环境中，这些感染通常在疟疾的诊断和治疗过程中被忽略，儿童通常更容易受到这些感染的侵害，因为他们的免疫系统发育较差，可能无法充分暴露于这些感染中。获得额外的功能，有时会使成年人的免疫系统无法感染这些感染。此外，儿童具有独特的微妙生理机能，使他们更容易受到与这些感染相关的威胁生命的代谢和病理生理疾病的困扰。我们认为，这些并发感染的可能存在是迅速衰弱的主要原因之一，症状加重和延误恢复，这是儿童疟疾发作的典型症状。因此，这些经常被忽视的感染的并存可能在很大程度上解释了为什么疟疾仍然是热带地区许多流行国家对幼儿生存的主要威胁，在这些国家，尽管有广泛的传播途径，但由于疟疾造成的年度死亡人数仍然高得令人无法接受相对有效的预防，预防和治疗选择范围（11、12）。因此，有必要强调这些并发感染在不同儿童群体中的流行和可能的病理生理学意义，作为努力了解儿童疟疾某些事件的复杂性和意外后果的努力的一部分。在这项研究中，检查了怀疑患有疟疾的儿童的粪便样本中是否存在两种原生动物寄生虫。

Concurrent giardiasis and amoebiasis infections in Nigerian children diagnosed with Plasmodium falciparum malaria: prevalence and pathophysiological implications.

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