Incidence Of Concurrent Malaria And Typhoid Fever Infections In Febrile Patients In Jos, Plateau State Nigeria.
Ukaegbu, C. O., Nnachi, A. U., Mawak, J. D., Igwe, C. C.
Index Terms: Co-infection, Febrile Patients, Malaria, Plasmodium spp., Salmonella spp., Typhoid
Abstract: Malaria and typhoid fever are major aetiological considerations in both acute and prolonged fever of unknown origin (PUO) in the tropics. Because of the high prevalence of malaria and typhoid fever in Nigeria, co-infections are common. This study investigated the incidence of Salmonella enterica serovar typhi and Plasmodium species in febrile patients in Jos, Nigeria. A total of 300 each of blood and stool samples were collected from patients presenting febrile conditions suggestive of malaria and typhoid fever and analyzed using parasitological, agglutination (Widal) and stool culture techniques. All isolates were identified as Salmonella enteric serovar typhi using standard microbiological techniques. The results revealed that 162(54%) patients were positive for malaria parasites out of which 68(42%) had typhoid fever by Widal test and 9(5.6%) by stool culture test. A correlation analysis showed a strong relationship between malaria parasite and Salmonella typhi both by Widal test (r=0.98) and by stool culture (r=0.91) tests. The result showed that malaria is more likely to cause fever than typhoid infection. It is therefore pertinent to suggest that every treatment of fever should be preceded by appropriate laboratory diagnosis that can establish the actual aetiology. The use of widal test alone in the diagnosis of typhoid fever is unreliable, misleading and should be discouraged. Culture technique still remains the gold standard in the diagnosis of typhoid fever and should be embraced. In the absence of culture facilities, widal test can be used provided judicious interpretation of the test result is made against a background of pertinent information. Also where culture facilities are lacking and patients show positive for malaria and widal test, malaria should be treated first. Only when malaria has been ruled out should such patients be treated for typhoid fever.
 A. F. Cowman, D. Berry and J. Baum, "The cellular and molecular basis for malaria parasite invasion of the human red blood cell", Journal of Cell Biology, vol. 198, no. 6, pp. 961–971, 2012.
 N. A. Beare, T. E. Taylor, S. P. Harding, S. Lewallen, M. E. Molyneux. "Malarial retinopathy: A newly established diagnostic sign in severe malaria". American Journal of Tropical Medicine and Hygiene, vol. 75, no. 5, pp. 790–797, 2006.
 S. P. Layne, "Principles of Infectious Disease Epidemiology", EPI 220, UCLA Department of Epidemiology, Archived from the original on 2006-02-20. Retrieved 2007-06-15.
 C. J. Sutherland, N. Tanomsing, D. Nolder, M. Oguike, C. Jennison, S. Pukrittayakamee, C. Dolecek, T. T. Hien, V. E. do Rosário, A. P. Arez, J. Pinto, P. Michon, A. A. Escalante, F. Nosten, M. Burke, R. Lee, M. Blaze, T. D. Otto, J.W. Barnwell, A. Pain, J. Williams, N. J. White, N. P. Day, G. Snounou, P. J. Lockhart, P. L. Chiodini, M. Imwong and S.D. Polley, “Two non-recombining sympatric forms of the human malaria parasite Plasmodium ovale occur globally”, Journal of Infectious Diseases, vol. 201, no. 10, pp. 1544-1550, 2010.
 B. Singh, K. L. Sung, A. Matusop, A. Radhakrishnan, S. Shamsul, J. Cox-Sing and T. A. Conway, “A large focus of naturally acquired Plasmodium konwlesi infections in human beings”, The Lancet, vol. 365, no. 9414, pp. 1017-1024, 2004.
 G. M. L. Nayyar, J. G. Breman, P. N. Newton and J. Herrington, "Poor-quality antimalarial drugs in southeast Asia and sub-Saharan Africa", Lancet Infectious Diseases, vol. 12, no. 6, pp. 488–96, 2012.
 C. J. Murray, L. C. Rosenfeld, S. S. Lim, K. G. Andrews, K. J. Foreman, D. Haring, N. Fullman, M. Naghavi, R. Lozano and A. D. Lopez, "Global malaria mortality between 1980 and 2010: A systematic analysis", Lancet, vol. 379, no. 9814, pp. 413–431, 2012.
 E. Worrall, S. Basu and K. Hanson, "Is malaria a disease of poverty? A review of the literature", Tropical Health and Medicine, vol. 10, no. 10, pp. 1047–1059, 2005.
 C. J. Uneke, “Concurrent Malaria and Typhoid Fever in the Tropics: the Diagnostic Challenges and Public Health Implications”, Journal of Vector Borne Diseases, vol. 45, pp. 133-142, 2008.
 A. C. Nwuzo, R. A. Onyeagba, I. R. Iroha, O. Nworie and A. E. Oji, “Parasitological, bacteriological and cultural determination of prevalence of malaria parasite (Plasmodium falciparium) and typhoid fever co-infection in Abakaliki, Ebonyi State, Scientific Research and Essay, vol. 4, no. 10, pp. 966-971.
 C. M. Parry, T. T. Hien, G. Dougan, N. J. White and J. J. Farrar, “Typhoid fever”, New England Journal of Medicine, vol. 347, 1770-1782, 2002.
 T. Butter, “Typhoid fever In: J. B. Wyngaargen, L. H. Smith, J. C. Bennett, editors. “Cecill Textbook of Medicine”, XIX edition, Philadelphia, U.S.A: W.B. Saunders Co., pp. 1690-1692, 2002.
 R. D. Pearson and R. L. Guerrant, “Enteric fever and other causes of abdominal symptoms with fever In: G. L. Mandell, J. E. Bennett and R. Dolin, editors, Principles and Practice of Infectious Diseases, V edition, New York: Churchill Livingstone, pp. 1136-1150, 2000.
 "Typhoid Fever". World Health Organization. Retrieved 2007-08-28.
 R. Lozano, "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010." Lancet vol. 380, no. 9859, pp. 2095–128, 2012.
 D. L. Heymann, editor, “Control of Communicable Diseases Manual”, Washington, D.C.: American Public Health Association, pg 665, 2008.
 Z. A. Bhutta, I. A. Khan and A. M. Molla, "Therapy of multidrug-resistant typhoid fever with oral cefixime vs. intravenous ceftriaxone", Pediatric Infectious Disease Journal, vol. 13, no. 11, pp. 990–993, 1994.
 B. C. M. Keong and W. Sulaiman, “Typhoid and malaria co-infection – an interesting finding in the investigation of a tropical fever”, Malaysian Journal of Medical Sciences, vol. 13, no. 1, pp. 74-75, 2006.
 C. Igbeneghu, M. J. Olisekodiaka and J. A. Onuegbu, “Malaria and Typhoid Fever among Adult Patients Presenting with Fever in
Ibadan, Southwest Nigeria”. International Journal of Tropical Medicine, vol. 4, no. 3, pp. 112-115, 2009.
 World Health Organization, “World malaria report 2011”, http://www.who.int/malaria/worldmalaria_report_2011/en/.
 D. C. Smith, “The rise and fall of typhomalarial fever II: origins, J. Hist. Med. Allied Sci., vol. 37, pp. 182-220, 1982.
 A. U. Opara, J. K. Nnodim, B. E. Oluwafemi and M. I. Nwachukwu, “Co-infection of malaria and typhoid fever among patients in Owerri, Imo State, Nigeria. Global Research Journal of Sciences, vol. 1, pp. 5-8, 2011.
 A. Ammah, T. Nkuo-Akenji, R. Ndip and J. E. Deas, “An update on concurrent malaria and typhoid fever in Cameroon”, Trans. R. Soc. Trop. Med. Hyg., vol. 93, pp. 127-129, 1999.
 M. E. Ohanu, A.U. Mbah, P.O. Okonkwo and S.P. Nwagbo, “Interference by malaria in the diagnosis of typhoid using Widal test alone”, West African Journal of Medicine, vol. 22, pp. 250-252, 2003.
 D. Sur, L. von Seidlein, B. Manna, S. Dutta, A. K. Deb, B. L. Sarkar, S. Kanungo, J. L. Deen, M. Ali, D. R. Kim, V. K. Gupta, R. L. Ochiai, A. Tsuzuki, C. J. Acosta, J. D. Clemens and S. K. Bhattacharya, “The malaria and typhoid fever burden in the slums of Kolkata, India: data from a prospective community-based study”, Trans. R. Soc. Trop. Med. Hyg., vol. 104, pp. 646-648, 2006.
 E. A. Igharo, F. Osazuwa, S. A. Ajayi, A. Ebueku and O. Igbinigie, “Dual infection with typhoid and malaria in febrile patients in Ikare Akoko, Nigeria”, International Journal of Tropical Medicine, vol. 7, no. 1, pp. 49-52, 2012.
 B. M. Greenwood, A. M. Bradley-Moore, A. Palit and A. D. M. Bryceson, “Immunosuppression in Children with malaria”, Lancet, vol. 1, pp. 169-172, 1972.
 D. Kaye and E. W. Hook, “The influence of haemolysis or blood loss on susceptibility to infection”, Journal of Immunology, vol. 91, pp. 65-75, 1963.
 F. A. Mbuh, M. Galadima and L. Ogbadu, “Rate of co-infection with malaria parasite and Salmonella typhi in Zaria, Kaduna State, Nigeria”, Annals of African Medicine, vol. 2, pp. 64-67, 2003.
 R. D. Ellis, M. M. Fukuda, P. McDaniel, K. Welich, A. Nisalak and C. K. Murvay, “Causes of fever in adults on the Thaimyanmar border”, International Journal of Tropical Medicine, vol. 74, pp. 108-113, 2006.
 B. M. Greenwood, K. Bojang, C. T. Wihithy and G. A. Targett, “Malaria”, Lancet, vol. 365, pp. 1487-1498.
 M. Cheesbrough, “District Laboratory Practice in Tropical Countries Part 1”, 2nd edition, Cambridge University Press, New York, p. 454, 2005.
 J. O. Ochei and A. A. Kolhatkar, “Medical Laboratory Science: Theory and Practice”, Tata McGraw-Hill, New Delhi, India, pp. 692-693, 962, 2010.
 K. N. Jhaveri, S. K. Nandwani, P. K. Mehta, R. R. Surati and B. D. Parmar, “False positive modified Widal test in acute malaria”, J. Assoc. Phys. India, vol. 43, pp. 754-755, 1995.
 E. F. Nsutebu, P. M. Ndumbe and S. Koulla, “The occurrence of typhoid fever in Cameroon: Over diagnosis due to misuse of the Widal test”, Trans. R. Soc. Trop. Med. Hyg., vol. 96, pp. 64-67, 2001.
 K. K. Samal and C. S. Sahu, “Malaria and widal reaction”, Journal of Association of Physicians, India, vol. 10, pp. 745-747, 1991.