Concomitant malaria among visceral leishmaniasis in-patients from Gedarif and Sennar States, Sudan: a retrospective case-control study

BMC Public Health

Henk DFH Schallig³  Bakri YM Nour⁵  Koert Ritmeijer⁴  Samira H Abdelrahman⁵  Hashim BM Ahmed⁵  Emily R Adams³  Al-Badawi A Talha¹  Pètra F Mens³  Ayman BYM Nour²  Marieke MZ Berkhout³  Erika van den Bogaart³ 

[1] Faculty of Medical Laboratory Sciences, University of Gezira, Wad Medani, Sudan;Blue Nile National Institute for Communicable Diseases, University of Gezira, Wad Medani, Sudan;Department of Biomedical Research, Parasitology Unit, Royal Tropical Institute (KIT), Amsterdam, the Netherlands;Public Health Department, Médecins Sans Frontières, Amsterdam, the Netherlands;Department of Medicine, Faculty of Medicine, University of Gedarif, and Gedarif Teaching Hospital, Kala Azar Ward, Gedarif, Sudan

关键词: Risk factors;    Mortality;    Prevalence;    Co-infection;    Malaria;    Visceral leishmaniasis;   

Others  :  1162349
DOI  :  10.1186/1471-2458-13-332

 received in 2012-08-05, accepted in 2013-04-01,  发布年份 2013

【 摘 要 】

Background

In areas where visceral leishmaniasis (VL) and malaria are co-endemic, co-infections are common. Clinical implications range from potential diagnostic delay to increased disease-related morbidity, as compared to VL patients. Nevertheless, public awareness of the disease remains limited. In VL-endemic areas with unstable and seasonal malaria, vulnerability to the disease persists through all age-groups, suggesting that in these populations, malaria may easily co-occur with VL, with potentially severe clinical effects.

Methods

A retrospective case-control study was performed using medical records of VL patients admitted to Tabarakallah and Gedarif Teaching Hospitals (Gedarif State) and Al`Azaza kala-azar Clinic (Sennar State), Sudan (2005-2010). Patients positively diagnosed with VL and malaria were identified as cases, and VL patients without microscopy-detectable malaria as controls. Associations between patient characteristics and the occurrence of the co-infection were investigated using logistic regression analysis. Confirmation of epidemiological outcomes was obtained with an independently collected dataset, composed by Médecins Sans Frontières (MSF) at Um-el-Kher and Kassab Hospitals, Gedarif State (1998).

Results

The prevalence of malaria co-infection among VL surveyed patients ranged from 3.8 to 60.8%, with a median of 26.2%. Co-infected patients presented at hospital with deteriorated clinical pictures. Emaciation (Odds Ratio (OR): 2.46; 95% Confidence Interval (95% CI): 1.72-3.50), jaundice (OR: 2.52; 95% CI: 1.04-6.09) and moderate anemia (OR: 1.58; 95% CI: 1.10-2.28) were found to be positively associated with the co-infection, while severity of splenomegaly (OR: 0.53; 95% CI: 0.35-0.81) and, to a less extent, hepatomegaly (OR: 0.52; 95% CI: 0.27-1.01) appeared to be reduced by concomitant VL and malaria. The in-hospital case-fatality rates did not significantly differ between co- and mono-infected patients (OR: 1.13; 95% CI: 0.59-2.17). Conversely, a significantly increased mortality rate (OR: 4.38; 95% CI: 1.83-10.48) was observed by MSF amongst co-infected patients enrolled at Um-el-Kher and Kassab Hospitals, who also suffered an enhanced risk of severe anemia (OR: 3.44; 95% CI: 1.68-7.02) compared to VL mono-infections.

Conclusions

In endemic VL areas with unstable seasonal malaria, like eastern Sudan, VL patients are highly exposed to the risk of developing concomitant malaria. Prompt diagnosis and effective treatment of malaria are essential to ensure that its co-infection does not result into poor prognoses.

【 授权许可】

   
2013 van den Bogaart et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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