title: Interactions and potential implications of Plasmodium falciparum-hookworm coinfection in different age groups in south-central Côte d'Ivoire.
abstract: BACKGROUND
  Given the widespread distribution of Plasmodium and helminth infections, and similarities of ecological requirements for disease transmission, coinfection is a common phenomenon in sub-Saharan Africa and elsewhere in the tropics. Interactions of Plasmodium falciparum and soil-transmitted helminths, including immunological responses and clinical outcomes of the host, need further scientific inquiry. Understanding the complex interactions between these parasitic infections is of public health relevance considering that control measures targeting malaria and helminthiases are going to scale.
  
  
  METHODS
  A cross-sectional survey was carried out in April 2010 in infants, young school-aged children, and young non-pregnant women in south-central Côte d'Ivoire. Stool, urine, and blood samples were collected and subjected to standardized, quality-controlled methods. Soil-transmitted helminth infections were identified and quantified in stool. Finger-prick blood samples were used to determine Plasmodium spp. infection, parasitemia, and hemoglobin concentrations. Iron, vitamin A, riboflavin, and inflammation status were measured in venous blood samples.
  
  
  RESULTS
  Multivariate regression analysis revealed specific association between infection and demographic, socioeconomic, host inflammatory and nutritional factors. Non-pregnant women infected with P. falciparum had significantly lower odds of hookworm infection, whilst a significant positive association was found between both parasitic infections in 6- to 8-year-old children. Coinfected children had lower odds of anemia and iron deficiency than their counterparts infected with P. falciparum alone.
  
  
  CONCLUSIONS
  Our findings suggest that interaction between P. falciparum and light-intensity hookworm infections vary with age and, in school-aged children, may benefit the host through preventing iron deficiency anemia. This observation warrants additional investigation to elucidate the mechanisms and consequences of coinfections, as this information could have important implications when implementing integrated control measures against malaria and helminthiases.
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Aurélie A
authors.initials: AA
authors.lastname: Righetti
authors.forename: Dominik
authors.initials: D
authors.lastname: Glinz
authors.forename: Lukas G
authors.initials: LG
authors.lastname: Adiossan
authors.forename: Ahou-Yah G
authors.initials: AY
authors.lastname: Koua
authors.forename: Sébastien
authors.initials: S
authors.lastname: Niamké
authors.forename: Richard F
authors.initials: RF
authors.lastname: Hurrell
authors.forename: Rita
authors.initials: R
authors.lastname: Wegmüller
authors.forename: Eliézer K
authors.initials: EK
authors.lastname: N'Goran
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000723:Ancylostomatoidea / Q000302:isolation & purification* / Q000472:pathogenicity; D000818:Animals; D001769:Blood / Q000469:parasitology; D001774:Blood Chemical Analysis; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology* / Q000469:parasitology*; D007560:Cote d'Ivoire / Q000453:epidemiology; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D005243:Feces / Q000469:parasitology; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006725:Hookworm Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology; D008297:Male; D010963:Plasmodium falciparum / Q000302:isolation & purification* / Q000472:pathogenicity; D014556:Urine / Q000469:parasitology; D055815:Young Adult
chemical_list: D016207:Cytokines; D006454:Hemoglobins