Mduluza-Jokonya Tariro L, Naicker Thajasvarie, Jokonya Luxwell, Midzi Herald, Vengesai Arthur, Kasambala Maritha, Choto Emilia, Rusakaniko Simbarashe, Sibanda Elopy, Mutapi Francisca, Mduluza Takafira
Optics & Imaging, Doris Duke Medical Research Institute, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
Department of Biochemistry, University of Zimbabwe, P.O. Box MP 167, Mt Pleasant, Harare, Zimbabwe.
BMC Public Health. 2020 Oct 19;20(1):1570. doi: 10.1186/s12889-020-09634-0.
Individuals living in Schistosoma haematobium endemic areas are often at risk of having other communicable diseases simultaneously. This usually creates diagnostic difficulties leading to misdiagnosis and overlooking of schistosomiasis infection. In this study we investigated the prevalence and severity of coinfections in pre-school age children and further investigated associations between S. haematobium prevalence and under 5 mortality.
A community based cross-sectional survey was conducted in Shamva District, Zimbabwe. Using random selection, 465 preschool age children (1-5 years of age) were enrolled through clinical examination by two independent clinicians for the following top morbidity causing conditions: respiratory tract infections, dermatophytosis, malaria and fever of unknown origin. The conditions and their severe sequels were diagnosed as per approved WHO standards. S. haematobium infection was diagnosed by urine filtration and the children were screened for conditions common in the study area which included HIV, tuberculosis, malnutrition and typhoid. Data was analysed using univariate and multinomial regression analysis and relative risk (RR) calculated.
Prevalence of S. haematobium was 35% (145). The clinical conditions assessed had the following prevalence in the study population: upper respiratory tract infection 40% (229), fever of unknown origin 45% (189), dermatophytosis 18% and malaria 18% (75). The odds of co-infections observed with S. haematobium infection were: upper respiratory tract infection aOR = 1.22 (95% CI 0.80 to 1.87), dermatophytosis aOR = 4.79 (95% CI 2.78 to 8.25), fever of unknown origin aOR = 10.63 (95% CI 6.48-17.45) and malaria aOR = 0.91 (95% CI 0.51 to1.58). Effect of schistosomiasis coinfection on disease progression based on the odds of the diseases progressing to severe sequalae were: Severe pneumonia aOR = 8.41 (95% CI 3.09-22.93), p < 0.0001, complicated malaria aOR = 7.09 (95% CI 1.51-33.39), p = 0.02, severe dermatophytosis aOR = 20.3 (95% CI 4.78-83.20):p = 0.03, and fever of unknown origin aOR = 1.62 (95%CI 1.56-4.73), p = 0.02.
This study revealed an association between schistosomiasis and the comorbidity conditions of URTI, dermatophytosis, malaria and FUO in PSAC living in a schistosomiasis endemic area. A possible detrimental effect where coinfection led to severe sequels of the comorbidity conditions was demonstrated. Appropriate clinical diagnostic methods are required to identify associated infectious diseases and initiate early treatment of schistosomiasis and co-infections in PSAC.
生活在埃及血吸虫病流行地区的个体常常同时面临感染其他传染病的风险。这通常会造成诊断困难，导致误诊并忽视血吸虫病感染。在本研究中，我们调查了学龄前儿童合并感染的患病率和严重程度，并进一步研究了埃及血吸虫病患病率与5岁以下儿童死亡率之间的关联。
在津巴布韦的沙姆瓦区开展了一项基于社区的横断面调查。通过随机选择，由两名独立的临床医生对465名学龄前儿童（1至5岁）进行临床检查，以筛查以下导致高发病率的疾病：呼吸道感染、皮肤癣菌病、疟疾和不明原因发热。按照世界卫生组织批准的标准对这些疾病及其严重后遗症进行诊断。通过尿液过滤诊断埃及血吸虫感染，并对儿童进行研究地区常见疾病筛查，包括艾滋病毒、结核病、营养不良和伤寒。使用单变量和多项回归分析对数据进行分析，并计算相对风险（RR）。
埃及血吸虫病的患病率为35%（145例）。在研究人群中，所评估的临床疾病患病率如下：上呼吸道感染40%（229例）、不明原因发热45%（189例）、皮肤癣菌病18%、疟疾18%（75例）。观察到的与埃及血吸虫感染合并出现的感染几率为：上呼吸道感染调整后比值比（aOR）=1.22（95%置信区间0.80至1.87），皮肤癣菌病aOR = 4.79（95%置信区间2.78至8.25），不明原因发热aOR = 10.63（95%置信区间6.48 - 17.45），疟疾aOR = 0.91（95%置信区间0.51至1.58）。基于疾病发展为严重后遗症的几率，血吸虫病合并感染对疾病进展的影响为：重症肺炎aOR = 8.41（95%置信区间3.09 - 22.93），p < 0.0001；复杂型疟疾aOR = 7.09（95%置信区间1.51 - 33.39），p = 0.02；重症皮肤癣菌病aOR = 20.3（95%置信区间4.78 - 83.20）：p = 0.03；不明原因发热aOR = 1.62（95%置信区间1.56 - 4.73），p = 0.02。
本研究揭示了血吸虫病与生活在血吸虫病流行地区的学龄前儿童上呼吸道感染、皮肤癣菌病、疟疾和不明原因发热等合并症之间的关联。研究表明合并感染可能产生有害影响，导致合并症出现严重后遗症。需要采用适当的临床诊断方法来识别相关传染病，并对学龄前儿童的血吸虫病及合并感染尽早进行治疗。
