Abstract
The study of the interactions among parasites within their hosts is crucial to the understanding of epidemiology of disease and for the design of effective control strategies. We have conducted an assessment of infections with Loa loa, Mansonella perstans, Wuchereria bancrofti, and Plasmodium falciparum in eastern Cameroon using a highly sensitive and specific quantitative polymerase chain reaction assay using archived dried whole blood spots. The resident population (N = 1,085) was parasitized with M. perstans (76%), L. loa (39%), and P. falciparum (33%), but not with W. bancrofti. Compared with single infections (40.1%), coinfection was more common (48.8%): 21.0% had L. loa–M. perstans (Ll+/Mp+/Pf−), 2.7% had L. loa–P. falciparum (Ll+/Pf+/Mp−), 15.1% had M. perstans–P. falciparum (Mp+/Pf+/Ll−), and 10.0% had L. loa–M. perstans–P. falciparum (Ll+/Mp+/Pf+). Interestingly, those with all three infections (Ll+/Mp+/Pf+) had significantly higher L. loa microfilaria (mf) counts than either single Ll+ (P = 0.004) or double Ll+/Mp+ (P = 0.024) infected individuals. Of those infected with L. loa, the mean estimated counts of L. loa mf varied based on location and were positively correlated with estimated intensities of M. perstans mf. Finally, at a community level, heavy L. loa infections were concentrated in a few individuals whereby they were likely the major reservoir for infection.
Highlights
IntroductionHumans are subject to infection by a variety of parasites (protozoan and metazoan) throughout their life
Humans are subject to infection by a variety of parasites throughout their life
A total of 1,170 samples were tested for L. loa, W. bancrofti, and M. perstans and for P. falciparum detection and quantification
Summary
Humans are subject to infection by a variety of parasites (protozoan and metazoan) throughout their life. Multiple parasitic infections are the rule, given their overlapping endemicity.[1] Helminth coinfections alone affect over 800 million people and outnumber single (or no) infection in many communities living in low-income, resourcelimited parts of the world.[2,3,4,5,6]. Soil-transmitted helminths (hookworms, Ascaris, and Trichuris) represent the greatest proportion of coinfecting species,[7,8,9,10] blood-borne infections involving filarial and malarial parasites have been described in many parts of the world. Dual infections with Plasmodium spp. and either Loa loa, Mansonella perstans or Mansonella ozzardi, three clinically less-important filarial parasites, have been seen in populations living in Uganda, Cameroon, and Argentina.[10,15,16,17]
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