Insights from respiratory virus co-infections

Respiratory viral co-infections present significant challenges in clinical settings due to their impact on disease severity and patient outcomes.Current diagnostic methods often miss these co-infections,complicating the epidemiology and management of these cases.Research,primarily conducted in vitro and in vivo,suggests that co-infections can lead to more severe illnesses,increased hospitalization rates,and greater healthcare utilization,especially in high-risk groups such as children,the elderly,and immunocompromised individuals.Common coinfection patterns,risk factors,and their impact on disease dynamics highlight the need for advanced diagnostic techniques and tailored therapeutic strategies.Understanding the virological interactions and immune response modulation during co-infections is crucial for developing effective public health interventions and improving patient outcomes.Future research should focus on the molecular mechanisms of co-infection and the development of specific therapies to mitigate the adverse effects of these complex infections.

Hepatitis B and C virus co-infections in human immunodeficiency virus positive North Indian patients

AIM： To determine the prevalence of hepatitis B and C virus infections in human immunodeficiency virus （HIV） -positive patients at a tertiary care hospital in New Delhi, India. METHODS： Serum samples from 451 HIV positive patients were analyzed for HBsAg and HCV antibodies during three years （Jan 2003-Dec 2005）. The control group comprised of apparently healthy bone-marrow and renal donors. RESULTS： The study population comprised essentially of heterosexually transmitted HIV infection. The prevalence Fate of HBsAg in this population was 5.3% as compared to 1.4% in apparently healthy donors （P 〈 0.001）. Though prevalence of HCV co-infection （2.43%） was lower than HBV in this group of HIV positive patients, the prevalence was significantly higher （P 〈 0.05） than controls （0.7%）. Triple infection of HIV, HBV and HCV was not detected in any patient. CONCLUSION： Our study shows a significantly high prevalence of hepatitis virus infections in HIV infected patients. Hepatitis viruses in HIV may lead to faster progression to liver cirrhosis and a higher risk of antiretroviral therapy induced hepatotoxicity. Therefore, it would be advisable to detect hepatitis virus coinfections in these patients at the earliest.

HIV,HCV,and HBV Co-Infections in a Rural Area of Shanxi Province with a History of Commercial Blood Donation

Background： Unhygienic blood collection in the early 1990s led to blood-borne infections in Central China. This study aimed to estimate human immunodeficiency virus （HIV） co-infection with hepatitis C and B viruses （HCV and HBV） and their risk factors in a rural area of Shanxi Province with a history of commercial blood donation. Methods： A cross-sectional study was conducted in 2004. All adult residents in the target area were invited to participate in the study. Face-to-face interviews were completed and blood specimens were tested for HIV, HCV, and HBV surface antigen （HBsAg）. Results： Prevalence rates of HIV, HCV, and HBsAg were 1.3% （40/3 062）, 12.7% （389/3 062）, and 3.5% （103/2982）, respectively. Of the 40 HIV-positive specimens, 85% were HCV positive and 2.5% were HBsAg positive. The history of commercial blood donation was positively associated with HIV, HCV, and HIV/HCV co-infections, but was negatively associated with HBsAg seropositivity. Migration for employment in the last 5 years was positively related to HIV, HBsAg, and HIV/HCV co-infections. Univariate logistic analysis showed that illegal drug use, number of sex partners, extramarital sex behavior, commercial sex behavior, and condom use rate were not related to anti-HIV, anti-HCV, HBsAg seropositivity or their co-infections. Conclusion： The history of commercial blood donation was the main risk factor for HIV, HCV, and HIV/HCV co-infections in this former commercial blood donation area. HIV and HCV prevention and treatment interventions are important in this area.

Chronic Lyme Disease Complex and Its Commonly Undiagnosed Primary and Secondary Co-Infections

Chronic Lyme disease complex describes the burden carried by patients infected with Borrelia burgdorferi as well as other co-infections or secondary co-infections (opportunistic infections). These infections can cause a significant burden on patients more so than Lyme disease alone. Along with the many underdiagnosed cases of Lyme disease throughout the world exists numerous undiagnosed co-infection and secondary co-infections leading to debilitating symptoms for many patients. The potential for co-infections varies by location as well as to the exposure to various species of ticks. Since there is potential for patients to experience several tick bites including those of different species, additional microorganisms also commonly transmitted via tick bite are included that are typically left out of the conversation of potential Borrelia burgdorferi co-infections. The most common co-infections of Lyme disease include anaplasmosis, babasiosis, bartonellosis and ehrlichiosis. Secondary co-infections or opportunistic infections commonly seen in patients with Lyme disease are also discussed. By helping to establish a comprehensive list of infections associated with Chronic Lyme disease complex may in fact help patients receive a proper diagnosis in order to administer the much needed comprehensive treatments patients deserve.

Viral co-infections among children with confirmed measles at hospitals in Hanoi,Vietnam,2014

Objective:To characterize viral co-infections among representative hospitalized measles cases during the 2014 Hanoi outbreak.Methods:Throat swabs were collected from 54 pediatric patients with confirmed measles,and molecular diagnostics performed for 10 additional viral respiratory pathogens(Influenza A/H1N1pdm09;A/H3N2 and influenza B;Parainfluenza 1,2,3;Respiratory Synctial Virus,RSV;human Metapneumovirus,hM PV;Adenovirus and Picornavirus).Results:Twenty-one cases(38.9%) showed evidence of infection with other respiratory viruses:15 samples contained measles plus one additional virus,and 6 samples contained measles plus 2 additional viruses.Adenovirus was detected as a predominant cause of co-infections(13 cases;24.1%),followed by RSV(6 cases;11.1%),A/H1N1pdm09(3 cases;5.6%),PIV3(3 cases;3.7%),Rhinovirus(3 cases;3.7%) and hM PV(1 case;1.96%).Conclusions:Viral co-infections identified from pediatric measles cases may have contributed to increased disease severity and high rate of fatal outcomes.Optimal treatment of measles cases may require control of multiple viral respiratory pathogens.

Rapid Detection Co-infections of Classical Swine Fever Virus and Porcine Reproductive and Respiratory Syndrome Virus by One-step Multiplex RT-PCR

Classical swine fever virus （CSFV） and porcine reproductive and respiratory syndrome virus （PRRSV） have caused immense economic loss in the pig industry and are considered to be the two most important infectious diseases of pigs in the world A multiplex reverse transcription polymerase chain reaction （multiplex RT-PCR） was developed for CSFV and PRRSV co-infections or infections, respectively. A set of two pairs of primer was designed based on the sequence of nonstructural protein NS54B of CSFV and ORF7 gene of PRRSV. The diagnostic accuracy of multiplex RT-PCR assay was evaluated by using 56 field clinical samples by multiplex RT-PCR, single RT-PCR and sequence analysis; and the specificity of multiplex PCR was verified by using constructed plasmids containing the specific viral target fragments of PRRSV and CSFV, respectively. The results indicated that this assay could reliably differentiate PRRSV and CSFV in co-infection samples. The multiplex RT-PCR developed in this study might provide a new avenue to the rapid the detection of CSFV and PRRSV in one reaction.

Cross-Sectional Study of Tuberculosis and HIV/AIDS Co-Infections among Patients Attending Directly Observed Treatment Centers in Bayelsa State, Nigeria

Introduction: Mycobacterium tuberculosis (TB) infects about one quarter of the global population and is transmitted via aerosols by coughing, sneezing, etc. Some socio-behavioral factors may predispose an individual to the disease. Methodology: The study used a cross-sectional design with random stratified sampling technique. Sputum samples from suspected TB patients totaling 600 were obtained from patients attending directly observed treatment (DOTs) centers from different local government areas in Bayelsa. The sputum samples were examined for tuberculosis using the Ziehl-Neelsen staining technique and Gene Xpert molecular method while HIV/AIDS tests were carried out with EDTA blood using the Alere HIV12 test kit and others. Results: The Prevalence of TB by Gene Xpert was 294 (49.0%) and by AFB 217 (36.1%), while TB/HIV co-infection was 94 (32.0%), RRMTB was 34 (11.9%) and HIV 249 (41.5%). Prevalence by age group showed the 20 - 39 years had the highest prevalence of TB 98 (47.0%), TB/HIV 35 (47.0%), RRMTB 17 (48.0%) and HIV 90 (57.0%). By gender the male had slightly higher prevalence of TB 109 (52.0%), TB/HIV 51 (54.0%), RRMTB 20 (56.0%) and HIV 126 (51.0%) than the female. Prevalence among smokers and alcoholics and subjects who engaged in both habits had high prevalence TB 109 (37.0%), TB/HIV 14 (40.0%), RRMTB 14 (40.0%) and HIV 72 (29.0%). For educational status those with tertiary and secondary education had similar high prevalence and for occupation, the self-employed and civil servants had similar elevated prevalence. The prevalence by local government area showed that Yenegoa had the highest with TB 235 (80.0%), TB/HIV 72 (76.6%), RRMTB 24 (68.5%) and HIV 202 (81.2%). Conclusion: An increase in the development of resistance by M. tuberculosis also contributes to the persistence of the disease as well as some socio-economic factors.

Implications of helminth immunomodulation on COVID-19 co-infections

Coronavirus disease 2019(COVID-19)and helminths infections can be in a synergistic epidemic in developing and suburban areas of industrialized countries.The coinfected hosts will derive a parasite-specific Th2 innate and adaptive immune response with CD4+T cells,eosinophils,interleukin-4,interleukin-5,and interleukin-10.In the early stages of severe acute respiratory syndrome coronavirus type 2(SARS-CoV-2)infection,virus-specific Th1 cytotoxic CD8+T cell,interleukin-6,interferon-γ,and interleukin-27 by lung are keys in controlling viral replication in the lung epithelial cells and limiting the pathology to other organs,like the intestine.CD4+and CD8+T cells are associated with protective immunity against and during COVID-19.However,viral evasion mechanisms occur.Interference of the interferon-γsecretion,like in helminths immunomodulation,can contribute to COVID-19 severity.Immunomodulation can result in mild,moderate,or severe COVID-19 depending on which helminth is coinfecting by regulating or avoiding host cytokine and pro-inflammatory response,decreasing viral load,and affecting vaccine-induced antibody response.We discuss the implications of immunomodulation on COVID-19 caused by helminth co-infection and for public health in the context of COVID-19 vaccine use in helminth endemic zones.

Factors of Adherence to Concurrent Tuberculosis Treatment and Antiretroviral Therapy among HIV-TB Co-Infected Individuals in the East Region, Cameroon in the COVID-19 Era: A Retrospective Cohort Study

Context/Objectives: Tuberculosis (TB) and HIV co-infection is a serious health problem in Cameroon. The problems associated with poor adherence to treatment are on the increase worldwide. This problem can be observed in all situations where patients are required to administer their own medication, whatever the type of illness. The general objective of this study was to assess the factors affecting adherence to treatment among HIV-TB co-infected patients in health facilities in the East Region in the COVID context. Method: A retrospective cohort study before and during COVID-19 was conducted in HIV care units in 13 health districts in the East Region of Cameroon. Data were collected using a questionnaire recorded in the Kobo Collect android application, analyzed using SPSS version 25 software and plotted using Excel. Results: The pre-COVID-19 cohort compared to the during-COVID-19 cohort had a 1.90 risk of not adhering to treatment (OR: 1.90, CI {1.90 - 3.37}) and the difference was statistically significant at the 5% level (p-value = 0.029). Frequency of adherence was 65.4% (140/214). Adherence before COVID-19 was 56.9% whereas during COVID-19, it was 74.3%. Conclusion: The implementation of targeted interventions in the COVID-19 context, using evidence-based data and integrating the individual needs of HIV-TB co-infected patients, improved adherence to concurrent anti-tuberculosis treatment and antiretroviral therapy during the COVID-19 Era.

Socio-Demographic and Occupational Aspects of HIV-HBV Co-Infection in Bangui, Central African Republic (CAR): Hospital-Based Cross-Sectional Study

Objective: HIV-HBV co-infection is a major public health problem that has not been sufficiently explored in the Central African workplace. The aim of this study was to assess the frequency of HIV-HBV co-infection among people who living with HIV (PLHIV) in the infectious and tropical diseases department of the Centre Hospitalier Universitaire de lAmiti Sino-Centrafricaine in Bangui. Methods: A retrospective study was carried out from January 1, 2010 to December 31, 2021 in the Infectious and Tropical Diseases Department at the Amiti Sino-Centrafricaine University Hospital. It included the files of all PLHIV, which included the results of HBV serology. A standardized form was used to collect socio-demographic and professional data by documentary review. Data was analysed using Epi-Info 7 software. Means, proportions were calculated as well as Chi square witch was significant if p-value was below 0.05. Results: The study included 265 patients, 188 were women (70.1%) and 77 men (29.1%), giving a sex ratio of 0.45. Mean age was 35.8 years, higher in men (40 years) than in women (35.8 years) (p 0.0001). The age groups 25 to 34 (37.7%) and 35 to 44 (33.6%) were in the majority (71.3%). The majority of PLHIV were unemployed (57.1%), including housewives (43.0%). HBV prevalence was 14.3%, including 7.2% among the unemployed, who account for half of all co-infections. The search for associations between HIV-HBV co-infection and all socio-demographic characteristics (age, sex, marital status) and socio-professional categories showed no significant difference (p 0.05). Conclusion: PLHIV were predominantly young adults, female, and unemployed;no occupation was significantly associated with co-infection. The vast majority of co-infected people were not covered by the occupational health system (unemployed or informal sector). Urgent action is needed to improve workers access to occupational medicine in CAR.

Mathematical Modeling of the Co-Infection Dynamics of HIV and Tuberculosis Incorporating Inconsistency in HIV Treatment

A non-linear HIV-TB co-infection has been formulated and analyzed. The positivity and invariant region has been established. The disease free equilibrium and its stability has been determined. The local stability was determined and found to be stable under given conditions. The basic reproduction number was obtained and according to findings, co-infection diminishes when this number is less than unity, and persists when the number is greater than unity. The global stability of the endemic equilibrium was calculated. The impact of HIV on TB was established as well as the impact of TB on HIV. Numerical solution was also done and the findings indicate that when the rate of HIV treatment increases the latent TB increases while the co-infected population decreases. When the rate of HIV treatment decreases the latent TB population decreases and the co-infected population increases. Encouraging communities to prioritize the consistent treatment of HIV infected individuals must be emphasized in order to reduce the scourge of HIV-TB co-infection.

Seroprevalence of hepatitis B,hepatitis C,human immunodeficiency virus,Treponema pallidum,and co-infections among blood donors in Kyrgyzstan:a retrospective analysis(2013-2015)

Background:Post-Soviet Kyrgyzstan has experienced a major surge in blood-borne infections,but data from adequately powered,up-to-date studies are lacking.We thus examined a)the seroprevalences of hepatitis B virus surface antigen(HBsAg),HIV-1 p24 antigen and antibodies against hepatitis C virus(anti-HCV),human immunodeficiency viruses(anti-HIV-1/2,HIV-1 group O),and Treponema pallidum among blood donors in Kyrgyzstan and assess their distribution according to sex,age,and provinces of residence;b)trends in the respective seroprevalences;and c)co-infection rates among the pathogens studied.Methods:Serological screening was performed on 37165 blood donors at the Republican Blood Centre in Bishkek,Kyrgyzstan,between January 2013 and December 2015.We applied poststratification weights to control for sampling bias and used logistic regression analyses to examine the association of seropositivity and co-infections with sex,age,provinces of residence,and year of blood donation.Results:Twenty nine thousand and one hundred forty-five(78%)donors were males and 8020(22%)were females.The median age was 27 years(range:18-64).The prevalences of HBsAg,anti-HCV,HIV(p24 Ag and anti-HIV),and anti-T.pallidum were 3.6%(95%CI:3.4-3.8%),3.1%(3.0-3.3%),0.78%(0.69-0.87%),and 3.3%(3.1-3.5%),respectively.Males were more likely to be seropositive for HBsAg than females(OR:1.63;95%CI:1.40-1.90),but less likely to be seropositive for anti-HCV(0.85;0.74-0.98)and HIV(0.65;0.49-0.85).Prevalences were lower in the capital than in the other provinces.There was a decreasing trend in the seroprevalences of HBsAg,anti-HCV,and anti-T.pallidum from 2012 to 2015(P-value for trend,P=0.01,P<0.0001,P<0.0001,respectively),while the seroprevalence of HIV increased(P=0.049).One hundred eighty donors(0.48%)were seropositive for multiple infections.The highest co-infection rate was observed between anti-T.pallidum and HBsAg(6.0%),followed by anti-HCV and anti-T.pallidum(5.2%),and HIV and anti-HCV(4.9%).Conclusions:The data suggest that Kyrgyzstan can be reclassified from high to lower-intermediate HBsAg endemicity,whereas the high HIV prevalence with a rising trend is an alarming finding that needs to be urgently addressed by public health authorities.The observed co-infections suggest common risk factors but also common preventive interventions.

Prevalence and Clinical Relevance of Schistosoma mansoni Co-Infection with Mycobacterium tuberculosis: A Systematic Literature Review

Tuberculosis disease stands for the second leading cause of death worldwide after COVID-19, most active tuberculosis cases result from the reactivation of latent TB infection through impairment of immune response. Several factors are known to sustain that process.Schistosoma mansoni, a parasite of the helminth genus that possesses switching power from an immune profile type Th1 to Th2 that favors reactivation of latent TB bacteria. The aim of the study was to assess the prevalence of the co-infection between the two endemic infections. Systematic literature was contacted at the University Clinical Research Center at the University of Sciences, Techniques, and Technologies of Bamako in Mali. Original articles were included, and full texts were reviewed to assess the prevalence and better understand the immunological changes that occur during the co-infection. In total, 3530 original articles were retrieved through database search, 53 were included in the qualitative analysis, and data from 10 were included in the meta-analysis. Prevalence of the co-infection ranged from 4% to 34% in the literature. Most of the articles reported that immunity against infection with helminth parasite and more specifically Schistosoma mansoni infection enhances latent TB reactivation through Th1/Th2. In sum, the impact of Schistosoma mansoni co-infection with Mycobacterium tuberculosis is under-investigated. Understanding the role of this endemic tropical parasite as a contributing factor to TB epidemiology and burden could help integrate its elimination as one of the strategies to achieve the END-TB objectives by the year 2035.

Impact of co-infections with enteric pathogens on children suffering from acute diarrhea in southwest China

Background:Acute diarrhea is a global health problem,resulting in high morbidity and mortality in children.It has been suggested that enteric pathogen co-infections play an important role in gastroenteritis,but most research efforts have only focused on a small range of species belonging to a few pathogen groups.This study aimed to assess the impact of co-infections with a broad range of enteric pathogens on children aged below five years who suffer from acute diarrhea in southwest China.Method:A total of 1020 subjects(850 diarrhea cases and 170 healthy controls)were selected from four sentinel hospitals in Kunming,Yunnan province,southwest China,from June 2014 to July 2015.Stool specimens were collected to detect five virus(rotavirus group A,RVA;norovirus,NoV;Sapovirus,SaV;astrovirus,As;and adenovirus,Ad),seven bacterial(diarrheagenic Escherichia coli,DEC;non-typhoidal Salmonella,NTS;Shigella spp.;Vibrio cholera;Vibrio parahaemolyticus;Aeromonas spp.;and Plesiomonas spp.),and three protozoan(Cryptosporidium spp.,Giardia lamblia,and Blastocystis hominis,B.hominis)species using standard microbiologic and molecular methods.Data were analyzed using the partial least square regression technique and chi-square test.Results:At least one enteric pathogen was detected in 46.7%(n=397)of acute gastroenteritis cases and 13.5%(n=23)of healthy controls(χ^(2)=64.4,P<0.05).Single infection with RVA was associated with acute diarrhea(26.5%vs.5.8%,P<0.05).The prevalence of a single infection with B.hominis in diarrhea cases was higher than in healthy controls(3.1%vs.0.5%,OR=4.7,95%CI:1.01–112.0).Single infection with NoV GII was not associated with diarrhea(4.4%vs.3.5%,OR=1.2,95%CI:0.5–3.3).Single infections with bacterial species were not observed.The prevalence of co-infections with two enteric pathogens in diarrhea cases was higher than in asymptomatic children(20.1%vs.5.3%,P<0.05).RVA-NoV GII was the most common co-infection in symptomatic children(4.4%),with it aggravating the severity of diarrhea.Conclusions:Although it is clear that RVA has an overwhelming impact on diarrhea illnesses in children,co-infection with other enteric pathogens appears to also aggravate diarrhea severity.These findings should serve as evidence for public health services when planning and developing intervention programs.

Co-infections with Babesia microti and Plasmodium parasites along the China-Myanmar border

Background:Babesiosis is an emerging health risk in several parts of the world.However,little is known about the prevalence of Babesia in malaria-endemic countries.The area along the China-Myanmar border in Yunnan is a main endemic area of malaria in P.R.China,however,human infection with Babesia microti(B.microti)is not recognized in this region,and its profile of co-infection is not yet clear.Methods:To understand its profile of co-infections with B.microti,our investigation was undertaken in the malaria-endemic area along the China-Myanmar border in Yunnan between April 2012 and June 2013.Four parasite species,including B.microti,Plasmodium falciparum(P.falciparum),P.vivax,and P.malariae,were identified among 449 suspected febrile persons detected by nested polymerase chain reaction(PCR)assay based on small subunit ribosomal ribonucleic acid(RNA)genes of B.microti and Plasmodium spp.Results:Of all the collected samples from febrile patients,mono-infection with B.microti,P.vivax,P.falciparum,and P.malariae accounted for 1.8%(8/449),9.8%(44/449),2.9%(13/449),and 0.2%(1/449),respectively.The rate of mixed infections of B.microti with P.falciparum or P.vivax are both 0.2%(1/449),and mixed infections of P.falciparum and P.vivax accounted for 1.1%(5/449).Conclusions:This report supports the hypothesis that babesiosis caused by B.microti is emerging along the China-Myanmar border in the Yunnan province,P.R.China,but it was ignored because of low parasitemia or mixed infection with Plasmodium spp.More sensitive and specific diagnosis methods are needed to find the rapid response mechanism of emergency for babesiosis and malaria co-prevalence areas.

HIV and intestinal parasite co-infections among a Chinese population: an immunological profile

Background:Parasite infections often result in a switch of the human body’s predominant immune reaction from T-helper 1(Th1)-type to Th2-type.Hence,parasite infections are widely expected to accelerate the progression of human immunodeficiency virus(HIV)infections to acquired immunodeficiency syndrome(AIDS).In the People’s Republic of China,both parasitic diseases and AIDS are epidemic in certain rural areas,and co-infections are relatively common.However,no population-based studies have yet investigated the frequency of HIV and parasite co-infections,and its effects on immune responses.We studied(1)the immune status of an HIV-infected population,and(2)the effect of co-infection of HIV and intestinal parasites on selected parameters of the human immune system.Methods:A total of 309 HIV-infected individuals were recruited and compared to an age-matched and sex-matched control group of 315 local HIV-negative individuals.Questionnaires were administered to all participants to obtain information on sociodemographic characteristics,sanitation habits,family income,and recent clinical manifestations.Two consecutive stool samples and 10 ml samples of venous blood were also collected from each individual for the diagnosis of parasite infections and quantitative measurements of selected cytokines and CD4+T-lymphocytes,respectively.Results:During the study period,79 HIV-infected individuals were not under highly active antiretroviral therapy(HAART)and were thus included in our analysis;the prevalence of intestinal helminth infections was 6.3%and that of protozoa was 22.8%.The most common protozoan infections were Blastocystis hominis(B.hominis)(13.9%)and Cryptosporidium spp.(10.1%).The prevalence of Cryptosporidium spp.in HIV-infected individuals was significantly higher than that in HIV negative individuals(P<0.05).Compared to the non-co-infected population,no significant difference was found for any of the measured immunological indicators(P>0.05).However,the following trends were observed:IFN-γlevels were lower,but the IL-4 level was higher,in the population co-infected with HIV and helminths.In the population co-infected with HIV and B.hominis,the IL-2 level was higher.The population co-infected with HIV and Cryptosporidium spp.had markedly lower CD4+T-lymphocyte counts.Conclusion:According to the immunologic profile, co-infection with helminths is disadvantageous to HIV-infected individuals. It was associated with a shift in the Th1/Th2 balance in the same direction as that caused by the virus itself, which might indicate an acceleration of the progress from an HIV infection to AIDS. Co-infection with Cryptosporidium spp. was not associated with a significant change in immune factors but co-infection with Cryptosporidium spp. was associated with a reduced level of CD4 + T-lymphocytes, confirming the opportunistic nature of such infections. Co-infection with B. hominis, on the other hand, was associated with an antagonistic shift in the immunological profile compared to an HIV infection.

Prevalence of and risk factors for malaria,filariasis,and intestinal parasites as single infections or co-infections in different settlements of Gabon,Central Africa

Background:Malaria,filariasis,and intestinal parasitic infections(IPIs)are common and frequently overlap in developing countries.The prevalence and predictors of these infections were investigated in three different settlements(rural,semi-urban,and urban)of Gabon.Methods:During cross-sectional surveys performed from September 2013 to June 2014,451 individuals were interviewed.In addition,blood and stool samples were analysed for the presence of Plasmodium,filarial roundworm,intestinal protozoan,and helminth infections.Results:Intestinal parasitic infections(61.1%),including intestinal protozoa(56.7%)and soil-transmitted helminths(STHs)(22.2%),predominated,whereas Plasmodium falciparum(18.8%),Loa loa(4.7%),and Mansonella perstans(1.1%)were less prevalent.Filariasis and STHs were mainly found in rural settlements,whereas a higher plasmodial infection prevalence rate was observed in the periurban area.The most common IPI was blastocystosis(48.6%),followed by ascaridiasis(13.7%),trichuriasis(11.8%),amoebiasis(9.3%),giardiasis(4.8%),and strongyloidiasis(3.7%).Hookworm was detected in one adult from rural Dienga.Adults had a higher prevalence of Blastocystis hominis and STHs,whereas Giardia duodenalis was more frequently observed among children aged below 5 years(P<0.01).The polyparasitism rate was 41.5%,with 7.0%Plasmodium-IPIs and 1.8%Plasmodium-STH co-infections.The multivariate analysis showed that living in a suburban area,belonging to the age group of 5-15 years,having none or a secondary education,or having an open body water close to home were significant risk factors for malaria(P≤0.01).For STH infections,identified risk factors were drinking untreated water and living in a rural area(P≤0.04).No significant predictors were identified for IPIs and malaria-IPI co-infection.Conclusions:This study reports a high prevalence of IPIs and intestinal protozoa,but a low rate of malaria-IPI co-infections in the study sites.Improvements in the living conditions of the population such as adequate water supply and proper health education and sanitation should be integrated into control strategies for malaria,STHs,and IPIs.

The global and regional prevalence of hepatitis C and B co-infections among prisoners living with HIV:a systematic review and meta-analysis

Background Hepatitis B virus(HBV)and hepatitis C virus(HCV)infections are common among individuals with human immune deficiency virus(HIV)infection worldwide.In this study,we did a systematic review and meta-analysis of the published literature to estimate the global and regional prevalence of HCV,HBV and HIV coinfections among HIV-positive prisoners.Methods We searched PubMed via MEDLINE,Embase,the Cochrane Library,SCOPUS,and Web of science(ISI)to identify studies that reported the prevalence of HBV and HCV among prisoners living with HIV.We used an eight-item checklist for critically appraisal studies of prevalence/incidence of a health problem to assess the quality of publications in the included 48 cross-sectional and 4 cohort studies.We used random-effect models and meta-regression for the meta-analysis of the results of the included studies.Results The number of the included studies were 50 for HCV-HIV,and 23 for HBV-HIV co-infections.The pooled prevalence rates of the coinfections were 12%[95%confidence interval(CI)9.0–16.0]for HBV-HIV and 62%(95%CI 53.0–71.0)for HCV-HIV.Among HIV-positive prisoners who reported drug injection,the prevalence of HBV increased to 15%(95%CI 5.0–23.0),and the HCV prevalence increased to 78%(95%CI 51.0–100).The prevalence of HBV-HIV coinfection among prisoners ranged from 3%in the East Mediterranean region to 27%in the American region.Also,the prevalence of HCV-HIV coinfections among prisoners ranged from 6%in Europe to 98%in the East Mediterranean regions.Conclusions Our findings suggested that the high prevalence of HBV and HCV co-infection among HIV-positive prisoners,particularly among those with a history of drug injection,varies significantly across the globe.The results of Meta-regression analysis showed a sliding increase in the prevalence of the studied co-infections among prisoners over the past decades,rising a call for better screening and treatment programs targeting this high-risk population.To prevent the above coinfections among prisoners,aimed public health services(e.g.harm reduction via access to clean needles),human rights,equity,and ethics are to be seriously delivered or practiced in prisons.

Dengue and falciparum malaria co-infection in travelers returning from Burkina Faso:Report of two cases in Northeastern Italy

Rationale: Malaria and dengue are the most prevalent vector-borne diseases in tropical countries. Plasmodium parasite and dengue virus(DENV) concurrent infection is possible and often under-recognized in geographical areas where these infections are both endemic.Patients concern and diagnosis: We describe the first two cases of Plasmodium falciparum and DENV-3 co-infection in travelers returning to northeastern Italy from Burkina Faso during 2013-2014.Interventions: Malaria infection in both patients was treated with mefloquine. Due to the persistence of symptoms despite of the antimalaria treatment, dengue was also investigated;the treatment of dengue was symptomatic.Outcomes: The patients were discharged in good general condition.Lessons: The need for surveillance of potential malaria and dengue co-infection in travelers returning to Europe from endemic areas is highlighted, as infection with Plasmodium does not exclude arboviral co-infection.

Viral haemorrhagic fevers and malaria co-infections among febrile patients seeking health care in Tanzania

Background:In recent years there have been reports of viral haemorrhagic fever(VHF)epidemics in sub-Saharan Africa where malaria is endemic.VHF and malaria have overlapping clinical presentations making diferential diagno‑sis a challenge.The objective of this study was to determine the prevalence of selected zoonotic VHFs and malaria co-infections among febrile patients seeking health care in Tanzania.Methods:This facility-based cross-sectional study was carried out between June and November 2018 in Buhigwe,Kalambo,Kyela,Kilindi,Kinondoni,Kondoa,Mvomero,and Ukerewe districts in Tanzania.The study involved febrile patients seeking health care from primary healthcare facilities.Blood samples were collected and tested for infections due to malaria,Crimean-Congo haemorrhagic fever(CCHF),Ebola virus disease(EVD),Marburg virus disease(MVD),Rift Valley fever(RVF)and yellow fever(YF).Malaria infections were tested using rapid diagnostics tests while exposure to VHFs was determined by screening for immunoglobulin M antibodies using commercial enzyme-linked immuno‑sorbent assays.The Chi-square test was used to compare the proportions.Results:A total of 308 participants(mean age=35±19 years)were involved in the study.Of these,54(17.5%)had malaria infection and 15(4.8%)were positive for IgM antibodies against VHFs(RVF=8;CCHF=2;EBV=3;MBV=1;YF=1).Six(1.9%)individuals had both VHF(RVF=2;CCHF=1;EVD=2;MVD=1)and malaria infections.The highest co-infection prevalence(0.6%)was observed among individuals aged 46‒60 years(P<0.05).District was signifcantly associated with co-infection(P<0.05)with the highest prevalence recorded in Buhigwe(1.2%)followed by Kinondoni(0.9%)districts.Headache(100%)and muscle,bone,back and joint pains(83.3%)were the most signifcant complaints among those infected with both VHFs and malaria(P=0.001).Conclusions:Co-infections of VHF and malaria are prevalent in Tanzania and afect more the older than the younger population.Since the overlapping symptoms in co-infected individuals may challenge accurate diagnosis,adequate laboratory diagnosis should be emphasized in the management of febrile illnesses.