University Medical Center Utrecht, Utrecht, The Netherlands.
PLoS One. 2011;6(7):e21013. doi: 10.1371/journal.pone.0021013. Epub 2011 Jul 6.
In sub-Saharan Africa, Plasmodium falciparum and hepatitis A (HAV) infections are common, especially in children. Co-infections with these two pathogens may therefore occur, but it is unknown if temporal clustering exists.
We studied the pattern of co-infection of P. falciparum malaria and acute HAV in Kenyan children under the age of 5 years in a cohort of children presenting with uncomplicated P. falciparum malaria. HAV status was determined during a 3-month follow-up period.
Among 222 cases of uncomplicated malaria, 10 patients were anti-HAV IgM positive. The incidence of HAV infections during P. falciparum malaria was 1.7 (95% CI 0.81-3.1) infections/person-year while the cumulative incidence of HAV over the 3-month follow-up period was 0.27 (95% CI 0.14-0.50) infections/person-year. Children with or without HAV co-infections had similar mean P. falciparum asexual parasite densities at presentation (31,000/µL vs. 34,000/µL, respectively), largely exceeding the pyrogenic threshold of 2,500 parasites/µL in this population and minimizing risk of over-diagnosis of malaria as an explanation.
The observed temporal association between acute HAV and P. falciparum malaria suggests that co-infections of these two hepatotrophic human pathogens may result from changes in host susceptibility. Testing this hypothesis will require larger prospective studies.
在撒哈拉以南非洲，疟原虫恶性疟（Plasmodium falciparum）和甲型肝炎（HAV）感染很常见，尤其是在儿童中。这两种病原体可能同时感染，但目前尚不清楚是否存在时间聚集性。
我们在肯尼亚一个年龄在 5 岁以下的患有单纯性疟原虫恶性疟的儿童队列中，研究了疟原虫恶性疟和急性 HAV 合并感染的模式。在 3 个月的随访期间确定 HAV 状态。
在 222 例单纯性疟疾中，有 10 例患者抗 HAV IgM 阳性。在疟原虫恶性疟期间发生 HAV 感染的发病率为 1.7（95%CI 0.81-3.1）感染/人年，而在 3 个月的随访期间 HAV 的累积发病率为 0.27（95%CI 0.14-0.50）感染/人年。有或没有 HAV 合并感染的儿童在就诊时的平均疟原虫无性体寄生虫密度相似（分别为 31,000/µL 和 34,000/µL），大大超过了该人群中 2,500 个寄生虫/µL 的发热阈值，从而最大限度地减少了将疟疾过度诊断为解释的风险。
急性 HAV 和疟原虫恶性疟之间观察到的时间关联表明，这两种嗜肝细胞人类病原体的合并感染可能是由于宿主易感性的变化所致。测试这一假设需要更大的前瞻性研究。
