Co-infection of Malaria and Typhoid Fever in Feverish Patients in the Kumba Health District, Southwest Cameroon: Public Health Implications
Lucy M. Ndip
Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Cameroon and Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon and Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX 77555, Texas, USA.
Franklyn N. Egbe
Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Cameroon.
Helen K. Kimbi *
Department of Zoology and Animal Physiology, University of Buea, Buea, Cameroon.
Henry A. Njom
Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Cameroon.
Roland N. Ndip
Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon and Department of Biochemistry and Microbiology, University of Fort Hare, Alice, South Africa.
*Author to whom correspondence should be addressed.
Abstract
Aims: This study was aimed at generating updated baseline data on co-infection of malaria and typhoid fever and finding out the implications of these co-infections in disease severity.
Study Design: The study was cross-sectional.
Place and Duration of Study: The study was carried out in Kumba, Southwest Cameroon from May to July, 2010.
Methodology: Venous blood was collected from 206 febrile patients of both sexes aged 4-80 years old at the Kumba District Hospital. Malaria parasite density and speciation were determined using Giemsa-stained thick and thin blood films respectively. Typhoid fever was diagnosed by isolation and characterisation of the aetiologic agent from stool samples in 178/206 patients. Antimicrobial susceptibility of recovered isolates was determined by the disc diffusion method. Anaemia status, Alanine aminotransferase (ALT) and Aspatate aminotransferase (AST) values were determined.
Results: Overall malaria prevalence was 90.3% (186/206) while geometric mean parasite density (GMPD) was 866 (range: 40 – 64880) parasites/µL of blood. Plasmodium falciparum was the most prevalent Plasmodium species. Overall prevalence of typhoid fever was 7.9% (14/178) while malaria/typhoid fever co-infection rate was 6.74% (12). Of the 14 typhoidal Salmonella isolates recovered, 6 were identified as Salmonella typhi and 8 as S. paratyphi. The Salmonella isolates were all susceptible to ciprofloxacin and gentamycin. Patients co-infected with malaria/typhoid fever had a significantly higher (P = .007) GMPD (1203, range: 100-64880 parasites/µL) when compared to patients with mono-infections of malaria (774, range: 40-18660 parasites/µL). Abnormal ALT and anorexia prevalence values were significantly higher (P=.01 and P =.045 respectively) in patients with only typhoid fever than their counterparts. The values of anaemia and AST were comparable in all groups of patients.
Conclusion: This study confirms that co-infections of malaria and typhoid fever are common and may exacerbate malaria intensity.
Keywords: Malaria, typhoid fever, co-infection, diagnosis, prevalence, severity, Cameroon.