2012 - 2018年肯尼亚维多利亚湖地区儿童疟原虫种类感染的非随机分布及相关临床特征

Non-random distribution of Plasmodium Species infections and associated clinical features in children in the lake Victoria region, Kenya, 2012-2018.

作者信息

Omondi Protus, Musyoka Brian, Okai Takatsugu, Kongere James, Kagaya Wataru, Chan Chim W, Ngara Mtakai, Kanoi Bernard N, Kido Yasutoshi, Gitaka Jesse, Kaneko Akira

机构信息

Department of Virology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.

Department of Parasitology/ Osaka International Research Center for Infectious Diseases, Osaka Metropolitan University, Osaka, Japan.

出版信息

Trop Med Health. 2024 Aug 5;52(1):52. doi: 10.1186/s41182-024-00622-3.

DOI:10.1186/s41182-024-00622-3

PMID:39103954

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11299388/

Abstract

BACKGROUND

While Plasmodium falciparum (Pf) stands out as the most lethal malaria parasite species in humans, the impact of other species should not be dismissed. Moreover, there is a notable lack of understanding of mixed-species infections and their clinical implications.

METHODS

We conducted eight school-based cross-sectional malariometric surveys in the Lake Victoria region of western Kenya between January-February 2012 and September-October 2018. In each survey, a minimum of 100 children aged 3 to 15 years were randomly chosen from a school in Ungoye village on the mainland and as well as from each school selected in every catchment area on Mfangano island. Plasmodium infection was determined by microscopy and nested polymerase chain reaction (PCR). The multiple-kind lottery (MKL) model calculated the expected distribution of Plasmodium infections in the population and compared it to observed values using a chi-squared test (χ).

RESULTS

The Plasmodium prevalence was 25.9% (2521/9724) by microscopy and 51.1% (4969/9724) by PCR. Among all infections detected by PCR, Pf, P. malariae (Pm), and P. ovale (Po) mono-infections were 58.6%, 3.1%, and 1.8%, respectively. Pf/Pm, Pf/Po, Pm/Po, and Pf/Pm/Po co-infections were 23.5%, 4.3%, 0.1%, and 8.6%, respectively. MKL modelling revealed non-random distributions, with frequencies of Pf/Pm and Pf/Pm/Po co-infections being significantly higher than expected (χ = 3385.60, p < 0.001). Pf co-infections with Pm and Po were associated with a decreased risk of fever (aOR 0.64, 95% CI 0.46-0.83; p = 0.01) and increased risks of splenomegaly (aOR 12.79, 95% CI 9.69-16.9; p < 0.001) and anaemia (aOR 2.57, 95% CI 2.09-3.15; p < 0.001), compared to single-species infections.

CONCLUSION

This study sheds light on the potential interaction between Pf and Pm and/or Po. Given the clinical significance of mixed-species infections, improved diagnostics, and case management of Pm and Po are urgently needed.

摘要

背景

虽然恶性疟原虫（Pf）是人类最致命的疟原虫物种，但其他物种的影响也不容忽视。此外，人们对混合物种感染及其临床意义的了解明显不足。

方法

2012年1月至2月至2018年9月至10月期间，我们在肯尼亚西部维多利亚湖地区开展了8次基于学校的横断面疟疾调查。每次调查中，从大陆Ungoye村的一所学校以及姆方加诺岛每个集水区选定的每所学校中随机挑选至少100名3至15岁的儿童。通过显微镜检查和巢式聚合酶链反应（PCR）确定疟原虫感染情况。多重类彩票（MKL）模型计算了人群中疟原虫感染的预期分布，并使用卡方检验（χ）将其与观察值进行比较。

结果

通过显微镜检查，疟原虫感染率为25.9%（2521/9724），通过PCR为51.1%（4969/9724）。在PCR检测到的所有感染中，Pf、三日疟原虫（Pm）和卵形疟原虫（Po）单感染分别为58.6%、3.1%和1.8%。Pf/Pm、Pf/Po、Pm/Po和Pf/Pm/Po混合感染分别为23.5%、4.3%、0.1%和8.6%。MKL模型显示分布非随机，Pf/Pm和Pf/Pm/Po混合感染的频率显著高于预期（χ = 3385.60，p < 0.001）。与单物种感染相比，Pf与Pm和Po的混合感染与发热风险降低相关（调整后比值比[aOR] 0.64，95%置信区间[CI] 0.46 - 0.83；p = 0.01），与脾肿大风险增加相关（aOR 12.79，95% CI 9.69 - 16.9；p < 0.001），与贫血风险增加相关（aOR 2.57，95% CI 2.09 - 3.15；p < 0.001）。