title: Prevalence and risk factors of intestinal protozoan and helminth infections among pulmonary tuberculosis patients without HIV infection in a rural county in P. R. China.
abstract: Although co-infection of tuberculosis (TB) and intestinal parasites, including protozoa and helminths, in humans has been widely studied globally, very little of this phenomenon is known in China. Therefore, a cross-sectional study was conducted in a rural county of China to investigate such co-infections. Patients with pulmonary TB (PTB) undergoing anti-Mycobacterium tuberculosis (anti-MTB) treatment were surveyed by questionnaires, and their feces and blood specimens were collected for detection of intestinal protozoa and helminths, routine blood examination and HIV detection. The χ(2) test and multivariate logistic regression model were used to identify risk factors. A total of 369 patients with PTB were included and all of them were HIV negative. Overall, only 7.3% of participants were infected with intestinal protozoa, among which prevalence of Blastocystis hominis, Entamoeba spp. and Trichomonas hominis were 6.0%, 1.1% and 0.3%, respectively; 7.0% were infected with intestinal helminths, among which prevalence of hookworm, Trichuris trichiura, Ascaris lumbricoides and Clonorchis sinensis were 4.3%, 1.9%, 0.5% and 0.3%, respectively; and 0.5% were simultaneously infected with intestinal protozoa and helminths. Among patients with PTB, body mass index (BMI)≤18 (OR=3.30, 95% CI=1.44-7.54) and raised poultry or livestock (e.g., chicken, duck, pig) (OR=3.96, 95% CI=1.32-11.89) were significantly associated with harboring intestinal protozoan infection, while BMI≤18 (OR=3.32, 95% CI=1.39-7.91), anemia (OR=3.40, 95% CI=1.44-8.02) and laboring barefoot in farmlands (OR=4.54, 95% CI=1.88-10.92) were significantly associated with having intestinal helminth infection. Additionally, there was no significant relationship between duration of anti-MTB treatment and infection rates of intestinal parasites including protozoa and helminths. Therefore, preventing malnutrition, avoiding unprotected contact with reservoirs of protozoa, and improving health education for good hygiene habits, particularly wearing shoes while outdoors, are beneficial in the prevention of intestinal protozoan and helminth infection among patients with PTB.
authors.affiliation: National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai 200025, PR China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Shanghai 200025, PR China; National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, PR China. Electronic address: lixinxu@chinatb.org.
authors.forename: Xin-Xu
authors.initials: XX
authors.lastname: Li
authors.affiliation: National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai 200025, PR China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Shanghai 200025, PR China.
authors.forename: Jia-Xu
authors.initials: JX
authors.lastname: Chen
authors.affiliation: National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, PR China.
authors.forename: Li-Xia
authors.initials: LX
authors.lastname: Wang
authors.affiliation: National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai 200025, PR China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Shanghai 200025, PR China.
authors.forename: Li-Guang
authors.initials: LG
authors.lastname: Tian
authors.affiliation: Gushi County Center for Disease Control and Prevention, Henan Province, Gushi 465200, PR China.
authors.forename: Yu-Ping
authors.initials: YP
authors.lastname: Zhang
authors.affiliation: Gushi County Center for Disease Control and Prevention, Henan Province, Gushi 465200, PR China.
authors.forename: Shuang-Pin
authors.initials: SP
authors.lastname: Dong
authors.affiliation: Gushi County Center for Disease Control and Prevention, Henan Province, Gushi 465200, PR China.
authors.forename: Xue-Guang
authors.initials: XG
authors.lastname: Hu
authors.affiliation: Gushi County Center for Disease Control and Prevention, Henan Province, Gushi 465200, PR China.
authors.forename: Jian
authors.initials: J
authors.lastname: Liu
authors.affiliation: Anhui Province Institute of Parasitic Disease Control, Hefei 230061, PR China.
authors.forename: Feng-Feng
authors.initials: FF
authors.lastname: Wang
authors.affiliation: Anhui Province Institute of Parasitic Disease Control, Hefei 230061, PR China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Anhui Province Institute of Parasitic Disease Control, Hefei 230061, PR China.
authors.forename: Xiao-Mei
authors.initials: XM
authors.lastname: Yin
authors.affiliation: Henan Province Center for Disease Control and Prevention, Zhengzhou 450016, PR China.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: He
authors.affiliation: Henan Province Center for Disease Control and Prevention, Zhengzhou 450016, PR China.
authors.forename: Qiu-Ye
authors.initials: QY
authors.lastname: Yan
authors.affiliation: Henan Province Center for Disease Control and Prevention, Zhengzhou 450016, PR China.
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Zhang
authors.affiliation: Henan Province Center for Disease Control and Prevention, Zhengzhou 450016, PR China.
authors.forename: Bian-Li
authors.initials: BL
authors.lastname: Xu
authors.affiliation: National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai 200025, PR China; Key Laboratory of Parasite and Vector Biology, Ministry of Health, WHO Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Shanghai 200025, PR China. Electronic address: xiaonongzhou1962@gmail.com.
authors.forename: Xiao-Nong
authors.initials: XN
authors.lastname: Zhou
mesh_terms: D000368:Aged; D000383:Agriculture; D000740:Anemia / Q000453:epidemiology*; D000818:Animals; D001196:Ascariasis / Q000453:epidemiology; D017164:Ascaris lumbricoides; D016776:Blastocystis Infections / Q000453:epidemiology; D016845:Blastocystis hominis; D002681:China / Q000453:epidemiology; D003003:Clonorchiasis / Q000453:epidemiology; D060085:Coinfection / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004747:Entamoeba; D004749:Entamoebiasis / Q000453:epidemiology; D005243:Feces / Q000469:parasitology; D005260:Female; D006373:Helminthiasis / Q000453:epidemiology*; D006376:Helminths; D006801:Humans; D006920:Hygiene; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology*; D058751:Livestock; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D015995:Prevalence; D011528:Protozoan Infections / Q000453:epidemiology*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013851:Thinness / Q000453:epidemiology*; D014245:Trichomonas Infections / Q000453:epidemiology; D014257:Trichuriasis / Q000453:epidemiology; D014258:Trichuris; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*
keywords: Intestinal helminth; Intestinal protozoan; P. R. China; Prevalence; Risk factor; Tuberculosis