Essam Madeleine Yvanna Nyangono, Kouam Arnaud Fondjo, Fepa Armelle Gaelle Kwesseu, Seukep Armel Jackson, Zeuko'o Elisabeth Menkem, Douanla Somene Felicité Syntia, Nembo Nembu Erastus, Moundipa Paul Fewou, Njayou Frédéric Nico
Department of Biochemistry, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon.
Department of Biomedical Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
PLoS One. 2025 May 23;20(5):e0319547. doi: 10.1371/journal.pone.0319547. eCollection 2025.
Malaria and typhoid fever remain major health issues in developing countries like Cameroon, with frequent co-infections. The potential liver damage caused by their respective causative pathogens is overlooked in health management, posing a significant risk of severe liver injury and worsening patient conditions. Accordingly, this study investigated the risk factors associated with liver damage in febrile patients with malaria, typhoid fever, or co-infection at the Obili District Medical Center and Mvog-Betsi Dominican Hospital Center, Yaoundé, Cameroon. Over 8 months, 350 febrile patients were evaluated for their adherence to preventive measures concerning malaria and typhoid fever using a structured questionnaire. Blood samples were analyzed for Plasmodium species and Salmonella antibodies and liver enzyme levels were measured. Liver damage was assessed using the Roussel Uclaf Causality Assessment Method. Risk factors for infections and liver damage were identified using Fisher's Exact and Chi-Square tests, with significance set at P < 0.05. Among participants tested, 129 (36.86%) and 106 (30.29%) were positive for malaria and typhoid, respectively, while 56 (16.00%) were co-infected. Men (49.2% and 37.3%) were more affected than women (30.6% and 26.7%) for both malaria and typhoid, respectively. Participants aged between 20 and 40 years were the most affected by malaria (21.4%) and typhoid fever (17.4%). The non-use of mosquito nets, presence of standing water, bushes, and garbage dumps near residences were significant risk factors (Relative risk: RR > 2.1; P < 0.0001) for contracting malaria or typhoid fever. The co-infection status (Chi-2 = 18.30; P < 0.0001), parasite density (Chi-2 = 9.8; P = 0.0074), and delay before consulting (Chi-2 = 13.23; P = 0.0013) were significant risk factors for the occurrence of liver injuries. Our findings demonstrated that the alteration of liver enzyme activity, reflecting liver damage among patients with malaria, typhoid, or malaria-typhoid co-infection, is a reality and should be considered during the patient treatment.
疟疾和伤寒热仍是喀麦隆等发展中国家的主要健康问题，且常出现合并感染情况。在健康管理中，它们各自的致病病原体所导致的潜在肝脏损伤被忽视，这带来了严重肝损伤及患者病情恶化的重大风险。因此，本研究在喀麦隆雅温得的奥比里区医疗中心和姆沃格 - 贝齐多米尼加医院中心，调查了疟疾、伤寒热或合并感染的发热患者中与肝损伤相关的风险因素。在8个多月的时间里，使用结构化问卷对350名发热患者就其对疟疾和伤寒热预防措施的依从性进行了评估。对血样进行了疟原虫种类和沙门氏菌抗体分析，并测量了肝酶水平。使用鲁塞尔·优克福因果关系评估法评估肝损伤情况。采用Fisher精确检验和卡方检验确定感染和肝损伤的风险因素，显著性设定为P < 0.05。在接受检测的参与者中，疟疾阳性者有129人（36.86%），伤寒阳性者有106人（30.29%），而合并感染者有56人（16.00%）。疟疾和伤寒分别对男性（49.2%和37.3%）的影响大于女性（30.6%和26.7%）。年龄在20至40岁之间的参与者受疟疾（21.4%）和伤寒热（17.4%）影响最大。不使用蚊帐、住所附近存在积水、灌木丛和垃圾场是感染疟疾或伤寒热的显著风险因素（相对风险：RR > 2.1；P < 0.0001）。合并感染状态（卡方 = 18.30；P < 0.0001）、寄生虫密度（卡方 = 9.8；P = 0.0074）以及就诊前的延误时间（卡方 = 13.23；P = 0.0013）是肝损伤发生的显著风险因素。我们的研究结果表明，反映疟疾、伤寒或疟 - 伤合并感染患者肝损伤的肝酶活性改变是实际存在的，在患者治疗过程中应予以考虑。
