Co-infection of Malaria and Typhoid Fever in Feverish Patients in the Kumba Health District, Southwest Cameroon: Public Health Implications

Aims: This study was aimed at generating updated baseline data on co-infection of malaria and typhoid fever and finding out the implications of these co-infections in disease severity.

Study Design: The study was cross-sectional.

Place and Duration of Study: The study was carried out in Kumba, Southwest Cameroon from May to July, 2010.

Methodology: Venous blood was collected from 206 febrile patients of both sexes aged 4-80 years old at the Kumba District Hospital. Malaria parasite density and speciation were determined using Giemsa-stained thick and thin blood films respectively. Typhoid fever was diagnosed by isolation and characterisation of the aetiologic agent from stool samples in 178/206 patients. Antimicrobial susceptibility of recovered isolates was determined by the disc diffusion method. Anaemia status, Alanine aminotransferase (ALT) and Aspatate aminotransferase (AST) values were determined.

Results: Overall malaria prevalence was 90.3% (186/206) while geometric mean parasite density (GMPD) was 866 (range: 40 – 64880) parasites/µL of blood. Plasmodium falciparum was the most prevalent Plasmodium species. Overall prevalence of typhoid fever was 7.9% (14/178) while malaria/typhoid fever co-infection rate was 6.74% (12). Of the 14 typhoidal Salmonella isolates recovered, 6 were identified as Salmonella typhi and 8 as S. paratyphi. The Salmonella isolates were all susceptible to ciprofloxacin and gentamycin. Patients co-infected with malaria/typhoid fever had a significantly higher (P = .007) GMPD (1203, range: 100-64880 parasites/µL) when compared to patients with mono-infections of malaria (774, range: 40-18660 parasites/µL). Abnormal ALT and anorexia prevalence values were significantly higher (P=.01 and P =.045 respectively) in patients with only typhoid fever than their counterparts. The values of anaemia and AST were comparable in all groups of patients.

Conclusion: This study confirms that co-infections of malaria and typhoid fever are common and may exacerbate malaria intensity.