Abstract
Eclipsed by the debates about malaria incidence and severity in individual patients, malaria transmission in helminth-infected persons has so far received very little attention. Studies in humans have shown increased malaria incidence and prevalence, and a trend for a reduction of symptoms in patients with malaria. This suggests that such patients could possibly be less likely to seek treatment thus carrying malaria parasites and their gametocytes for longer durations, therefore, being a greater potential source of transmission. In addition, in humans, a study showed increased gametocyte carriage, and in an animal model of helminth-malaria co-infection, there was increased malaria transmission. These elements converge towards the hypothesis that patients co-infected with worms and malaria may represent a hub of malaria transmission. The test of this hypothesis requires verifying, in different epidemiological settings, that helminth-infected patients have more gametocytes, that they have less symptomatic malaria and longer-lasting infections, and that they are more attractive for the vectors. The negative outcome in one setting of one of the above aspects does not necessarily mean that the other two aspects may suffice to increase transmission. If it is verified that patients co-infected by worms and malaria could be a transmission hub, this would be an interesting piece of strategic information in the context of the spread of anti-malarial resistance and the malaria eradication attempts.
Highlights
In the past decade, the topic of interactions between worms and malaria has generated a surge of interest with over 35 publications reporting findings in humans from different continents
There have been over 25 publications on different animal models of coinfection between worms and malaria [1]
The hypothesis Eclipsed by the debates about malaria incidence and severity in individual patients, malaria transmission in helminth-infected persons is an area that has so far received very little attention
Summary
The topic of interactions between worms and malaria has generated a surge of interest with over 35 publications reporting findings in humans from different continents. Most of the publications on coinfections in humans focussed on whether malaria was more or less frequent or whether malaria was more or less severe in patients with worms. The hypothesis Eclipsed by the debates about malaria incidence and severity in individual patients, malaria transmission in helminth-infected persons is an area that has so far received very little attention.
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