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Hookworm/Malaria coinfection

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Hookworm/Malaria coinfection
Other names: Malaria and helminth co-infection[1]
  • Top:Distribution of Hookworm and Malaria coinfection.[2]
  • Bottom:Concomitant helminth infection modified the immune response and susceptibility to Plasmodium infection[3]
SpecialtyInfectious disease
SymptomsSevere anemia, severe malnutrition, developmental delays in children[4][5][2]
CausesHookworm infection by Ancylostoma duodenale and Necator americanus[1]
Malaria by parasites of genus Plasmodium[1]
Diagnostic methodStool exam, blood smear[1]
TreatmentAntimalarials and antihelminthics[6][7]
Prevalencesub-Saharan Africa,[1]
Southeast Asia,
South America

Hookworm/Malaria coinfection is a health concern in many tropical and subtropical regions where both parasites are endemic. The interaction between these two infections is complex and can have different effects on individuals depending on factors such as the intensity of infection, species of malaria parasite and hookworm, and the hosts immune system status.[8][9]

Hookworm and malaria have a geographical overlap, particularly in sub-Saharan Africa and parts of Asia and South America.[10]

Signs and symptoms

The presentation demonstrate can be as follows:[6][7]

Anemia

Specific populations of children and pregnant women with hookworm-malaria coinfection may be at higher risk for more severe outcomes, including the following :[5][2][4]

Cause

The etiology of this coinfection is due to :

Mechanism

In terms of the mechanism, we find hookworm infections are known to induce strong immune-modulatory effects, skewing the immune response towards a Th2-dominated profile. This can suppress the Th1-mediated immune response, which is important for controlling malaria infections.Co-infections alter cytokine production, with both pro-inflammatory and anti-inflammatory cytokines being affected. This can influence the survival and replication of the Plasmodium parasite, increasing malaria transmission[13][14]

Hookworm and malaria contribute to anemia, but via different mechanisms. Hookworms cause chronic blood loss by attaching to intestinal mucosa and feeding on host blood, causing iron deficiency anemia. Malaria, on the other hand caused by Plasmodium falciparum, leads to hemolysis of infected red blood cells, exacerbating anemia.[15][1]

Diagnosis

As to the diagnosis we find that diagnostic methods for both conditions are done(the presence of one infection doesnt rule out the other, especially in regions where both diseases are endemic; overlapping symptoms of fever and anemia can make clinical diagnosis difficult):[8][16][17]

  • Stool examination for hookworm eggs
  • Blood smear microscopy and RDT for malaria parasites

Treatment

As to cases of severe malaria, the hookworm treatment can be started after the patient has stabilized on antimalarial therapy. For uncomplicated malaria, the treatments for both infections can often be given concurrently. The commonly used antimalarials and antihelminthics for hookworm do not have significant negative interactions(though adverse interactions do exist[18]).Both hookworm and malaria can contribute to anemia, iron supplementation should be considered and given to patients with significant anemia, in addition to treating the parasitic infections. In severe cases of anemia, blood transfusion may be given.[19][20][21]

Epidemiology

Density description next to color coded box refers to prevalence of P. falciparum, column to right refers to density of hookworm[22]

As to hookworm and malaria co-infections are common in regions where both parasites are endemic, particularly in sub-Saharan Africa, Southeast Asia, and South America. Studies suggest that co-infections can influence disease severity, immune responses, and anemia risk. A 2021 systematic review found that 17.7 percent of children in endemic areas had malaria-helminth co-infections[1]

Co-infection with hookworm and Plasmodium falciparum is common in Africa.[19] Although exact numbers are unknown, preliminary analyses estimate that as many as a quarter of African schoolchildren may be coincidentally at-risk of both P. falciparum and hookworm.[23] While original hypotheses stated that co-infection with multiple parasites would impair the host's immune response to a single parasite and increase susceptibility to clinical disease, studies have yielded contrasting results. For example, one study in Senegal showed that the risk of clinical malaria infection was increased in helminth-infected children in comparison to helminth-free children while other studies have failed to reproduce such results.[24]

History

The malaria parasite was first observed in blood of malaria patients by Charles Louis Alphonse Laveran(1880)[25]

Angelo Dubini is credited with first describing the hookworm parasite, Ancylostoma duodenale, in Italy(1838)[26]

In terms of the history of coinfection of hookworm and malaria, the historical tracking of its discovery as a significant co-occurrence and its implications has been a gradual recognition through epidemiological studies and clinical observations, in regions where both diseases are endemic.Recent research, by Graham and Budischak, has focused on understanding the ecological interactions between these coinfecting parasites and the implications for treatment strategies.[27]

See also

Notes

1.^ This is a cohort (not a review), the text was useful and therefore added

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Afolabi, Muhammed O.; Ale, Boni M.; Dabira, Edgard D.; Agbla, Schadrac C.; Bustinduy, Amaya L.; Ndiaye, Jean Louis A.; Greenwood, Brian (18 February 2021). "Malaria and helminth co-infections in children living in endemic countries: A systematic review with meta-analysis". PLOS Neglected Tropical Diseases. 15 (2): e0009138. doi:10.1371/journal.pntd.0009138. ISSN 1935-2735. PMC 7924789. PMID 33600494.
  2. ↑ 2.0 2.1 2.2 Hotez, Peter J.; Molyneux, David H. (30 July 2008). "Tropical anemia: one of Africa's great killers and a rationale for linking malaria and neglected tropical disease control to achieve a common goal". PLOS Neglected Tropical Diseases. 2 (7): e270. doi:10.1371/journal.pntd.0000270. ISSN 1935-2735. PMC 2474697. PMID 18665256.
  3. ↑ Salazar-Castañon, Víctor H.; Legorreta-Herrera, Martha; Rodriguez-Sosa, Miriam (2014). "Helminth parasites alter protection against Plasmodium infection". BioMed Research International. 2014: 913696. doi:10.1155/2014/913696. ISSN 2314-6141. PMC 4170705. PMID 25276830.
  4. ↑ 4.0 4.1 Brooker, S.; Miguel, E. A.; Moulin, S.; Luoba, A. I.; Bundy, D. A.; Kremer, M. (March 2000). "Epidemiology of single and multiple species of helminth infections among school children in Busia District, Kenya". East African Medical Journal. 77 (3): 157–161. doi:10.4314/eamj.v77i3.46613. ISSN 0012-835X. PMID 12858892. Archived from the original on 5 February 2025. Retrieved 22 April 2025.
  5. ↑ 5.0 5.1 Agu, Polycarp Uche; Ogboi, Johnbull Sonny; Akpoigbe, Kesiena; Okeke, Tochukwu; Ezugwu, Euzebus (2013). "Impact of Plasmodium falciparum and hookworm infections on the frequency of anaemia in pregnant women of rural communities in Enugu, South East Nigeria". The Pan African Medical Journal. 14: 27. doi:10.11604/pamj.2013.14.27.1925. ISSN 1937-8688. PMC 3597852. PMID 23503560.
  6. ↑ 6.0 6.1 Buck, Emily; Finnigan, Nancy A. (2025). "Malaria". StatPearls. StatPearls Publishing. PMID 31869175. Archived from the original on 2025-04-12. Retrieved 2025-04-28.
  7. ↑ 7.0 7.1 Ghodeif, Alhassan O.; Jain, Hanish (15 June 2023). "Hookworm". StatPearls [Internet]. StatPearls Publishing. PMID 31536254.
  8. ↑ 8.0 8.1 Pullan, Rachel L.; Kabatereine, Narcis B.; Bukirwa, Hasifa; Staedke, Sarah G.; Brooker, Simon (1 February 2011). "Heterogeneities and Consequences of Plasmodium Species and Hookworm Coinfection: A Population Based Study in Uganda". The Journal of Infectious Diseases. 203 (3): 406–417. doi:10.1093/infdis/jiq063. ISSN 0022-1899. PMC 3038339. PMID 21187338.
  9. ↑ Righetti, Aurélie A.; Glinz, Dominik; Adiossan, Lukas G.; Koua, Ahou-Yah G.; Niamké, Sébastien; Hurrell, Richard F.; Wegmüller, Rita; N'Goran, Eliézer K.; Utzinger, Jürg (2012). "Interactions and potential implications of Plasmodium falciparum-hookworm coinfection in different age groups in south-central Côte d'Ivoire". PLOS Neglected Tropical Diseases. 6 (11): e1889. doi:10.1371/journal.pntd.0001889. ISSN 1935-2735. PMC 3486899. PMID 23133691.
  10. ↑ Mahittikorn, Aongart; Masangkay, Frederick Ramirez; De Jesus Milanez, Giovanni; Kuraeiad, Saruda; Kotepui, Manas (27 April 2022). "Prevalence and effect of Plasmodium spp. and hookworm co-infection on malaria parasite density and haemoglobin level: a meta-analysis". Scientific Reports. 12 (1): 6864. Bibcode:2022NatSR..12.6864M. doi:10.1038/s41598-022-10569-2. ISSN 2045-2322. PMC 9046215. PMID 35477943.
  11. ↑ "Hookworm Infection - Infectious Diseases". MSD Manual Professional Edition. Retrieved 24 April 2025.
  12. ↑ "Fact sheet about malaria". www.who.int. Archived from the original on 2 May 2020. Retrieved 24 April 2025.
  13. ↑ Lo, Aminata Colle; Faye, Babacar; Gyan, Ben Adu; Amoah, Linda Eva (3 July 2018). "Plasmodium and intestinal parasite perturbations of the infected host's inflammatory responses: a systematic review". Parasites & Vectors. 11 (1): 387. doi:10.1186/s13071-018-2948-8. ISSN 1756-3305. PMC 6031113. PMID 29970128.
  14. ↑ Nacher, Mathieu (12 September 2011). "Interactions between worms and malaria: Good worms or bad worms?". Malaria Journal. 10 (1): 259. doi:10.1186/1475-2875-10-259. ISSN 1475-2875. PMC 3192711. PMID 21910854.
  15. ↑ Njua-Yafi, Clarisse; Achidi, Eric A.; Anchang-Kimbi, Judith K.; Apinjoh, Tobias O.; Mugri, Regina N.; Chi, Hanesh F.; Tata, Rolland B.; Njumkeng, Charles; Nkock, Emmanuel N.; Nkuo-Akenji, Theresa (6 February 2016). "Malaria, helminths, co-infection and anaemia in a cohort of children from Mutengene, south western Cameroon". Malaria Journal. 15 (1): 69. doi:10.1186/s12936-016-1111-2. ISSN 1475-2875. PMID 26852392.
  16. ↑ "CDC - DPDx - Intestinal Hookworm". www.cdc.gov. 17 September 2019. Archived from the original on 29 September 2022. Retrieved 23 April 2025.
  17. ↑ "Clinical Guidance: Malaria Diagnosis & Treatment in the U.S." Malaria. 5 June 2024. Archived from the original on 21 April 2025. Retrieved 23 April 2025.
  18. ↑ Gudisa, Bereda (6 May 2022). "Anthelmintic agents: vermicide and vermifuge". Insights in Biology and Medicine. 6 (1): 001–008. doi:10.29328/journal.ibm.1001020. Archived from the original on 3 June 2024. Retrieved 26 April 2025.
  19. ↑ 19.0 19.1 Brooker, Simon; Akhwale, Willis; Pullan, Rachel; Estambale, Benson; Clarke, Siân E.; Snow, Robert W.; Hotez, Peter J. (December 2007). "Epidemiology of plasmodium-helminth co-infection in Africa: populations at risk, potential impact on anemia, and prospects for combining control". The American Journal of Tropical Medicine and Hygiene. 77 (6 Suppl): 88–98. doi:10.4269/ajtmh.2007.77.88. ISSN 0002-9637. PMC 2637949. PMID 18165479. Archived from the original on 2025-05-03. Retrieved 2025-05-03.
  20. ↑ "Treatment of Severe Malaria". Malaria. 3 April 2024. Archived from the original on 3 May 2025. Retrieved 26 April 2025.
  21. ↑ "Anemia" (PDF). www.worldbank.org. Archived (PDF) from the original on 19 November 2023. Retrieved 3 May 2025.
  22. ↑ Afolabi, Muhammed O.; Adebiyi, Adekola; Cano, Jorge; Sartorius, Benn; Greenwood, Brian; Johnson, Olatunji; Wariri, Oghenebrume (September 2022). "Prevalence and distribution pattern of malaria and soil-transmitted helminth co-endemicity in sub-Saharan Africa, 2000-2018: A geospatial analysis". PLOS Neglected Tropical Diseases. 16 (9): e0010321. doi:10.1371/journal.pntd.0010321. ISSN 1935-2735. PMC 9555675. PMID 36178964.
  23. ↑ Brooker S, Clements AC, Hotez PJ, Hay SI, Tatem AJ, Bundy DA, Snow RW (2006). "The co-distribution of Plasmodium falciparum and hookworm among African schoolchildren". Malar. J. 5 (1): 99. Bibcode:2006MalJ....5...99B. doi:10.1186/1475-2875-5-99. PMC 1635726. PMID 17083720.
  24. ↑ Spiegel A, Tall A, Raphenon G, Trape JF, Druilhe P (2003). "Increased frequency of malaria attacks in subjects co-infected by intestinal worms and Plasmodium falciparum malaria". Trans. R. Soc. Trop. Med. Hyg. 97 (2): 198–9. doi:10.1016/S0035-9203(03)90117-9. PMID 14584377.
  25. ↑ "Alphonse Laveran – Facts". NobelPrize.org. Archived from the original on 2025-05-03. Retrieved 2025-04-25.
  26. ↑ Despommier, Dickson D.; Gwadz, Robert W.; Hotez, Peter J. (1995). "Hookworms: Necator americanus (Stiles 1902) and Ancylostoma duodenale (Dubini 1843)". Parasitic Diseases. Springer: 17–24. doi:10.1007/978-1-4612-2476-1_4. ISBN 978-1-4612-7554-1. Archived from the original on 17 June 2018. Retrieved 25 April 2025.
  27. ↑ Budischak, Sarah A.; Wiria, Aprilianto E.; Hamid, Firdaus; Wammes, Linda J.; Kaisar, Maria M. M.; van Lieshout, Lisette; Sartono, Erliyani; Supali, Taniawati; Yazdanbakhsh, Maria; Graham, Andrea L. (2018). "Competing for blood: the ecology of parasite resource competition in human malaria–helminth co-infections". Ecology Letters. 21 (4): 536–545. Bibcode:2018EcolL..21..536B. doi:10.1111/ele.12919. hdl:1887/86651. ISSN 1461-0248. PMID 29417715.

Further reading

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