COINFECTION OF MALARIA AND THYPHOID

ABSTRACT

Malaria and typhoid fever remain the diseases of major public health importance and cause of morbidity and mortality in tropical Africa. Both . diseases are common in many countries of the world where the prevailing environmental conditions of warm humid climate, poor sanitary habits, poverty and ignorance exist. Malaria and typhoid fever usually present similar symptoms particularly at the beginning of typhoid fever. It is sometimes very difficult to differentiate clinically the presentation of typhoid fever from that of malaria without laboratory support. Co-infection with malaria and typhoid is believed to be common and therefore the simultaneous treatment of both infections is quite rampant. This seminar therefore is on the differences, signs and symptoms, diagnosis and diagnostics dilemmas, and causes of confection of malaria and typhoid. From the review, it was found that a proper protocol is required to diagnose and treat the co-infection. Erroneous interpretation of the test result may lead to misdiagnosis and mismanagement of the patient, resulting in major morbidity and mortality. So interpretation of Widal test results, when diagnosing concurrent malaria and typhoid fever must therefore be done with a lot of caution. Also, delicate balance in body iron must be maintained for resistance to infections.

TABLE OF CONTENTS

Title page i
Approval Page ii
Dedication iii
Acknowledgement iv
Abstract v
Chapter One: Introduction 1
Chapter Two: Co-infection of Malaria and Typhoid 2
2.1 Differentiating Malaria and Typhoid by Signs and Symptoms 5
2.2 Concurrent Malaria and Enteric Fever 6
2.3 Diagnosis and Diagnostic Dilemmas 8
2.4 Causes of Co-Infection Misleading Widal results 10
2.5 False positive widal reaction 11
2.6 True Co-infection 12
Chapter Three: Conclusion 15
References 19
CHAPTER ONE
INTRODUCTION
Malaria and typhoid fever are well known undifferentiated febrile illnesses which could be responsible for varying degrees of morbidity and mortality in developing sub-Saharan countries including Nigeria (Ammah, Nkuo-Akenji, Ndip and Deas, 2009; Nsutebu, Ndumbe and Adiogo, 2003; Ukaegbo, Nnachi, Mawak and Igwe, 2014). Malaria and typhoid fever remain the diseases of major public health importance and cause of morbidity and mortality in tropical Africa (CDC, 2009; Abate, Degarege and Erko, 2013). Both . diseases are common in many countries of the world where the prevailing environmental conditions of warm humid climate, poor sanitary habits, poverty and ignorance exist. These two diseases have been associated with poverty and underdevelopment (CDC, 2009)
Malaria is transmitted by the bites of infected female Anopheles mosquitoes from one person to another. It is one of the most severe public health problems worldwide and leading causes of diseases and death in many developing countries, where young children and pregnant women are the groups most affected (Ikpeze, Ogaraku, Mbanugo, and Eneanya, 2012; WHO, 2013). Malaria is caused by parasites of the genus Plasmodium with its initial symptoms varying symptoms and may include irregular fever, malaise, headache, muscular pain, sweating, chills, nausea, vomiting and some diarrhoea and most of these symptoms are induced by the release of cytokines by the host’s immune system (Garg, 2010). Globally, an estimated half of the world population (3.4 billion persons) lives in areas at risk of malaria infection. Six countries in sub-Saharan Africa (Nigeria, Democratic Republic of the Congo, Tanzania, Uganda, Mozambique, and Cote d’Ivoire) account for an estimated 103 million malaria cases and 47% of the global total each year. Nigeria and the Democratic Republic of the Congo, together account for 40% of the estimated total global (Global Malaria Action Plan, 2013).
Malaria is holoendemic in Nigeria (Ukpai and Ajoku, 2001). Ninety percentage (90%) of Nigeria’s population are at risk of malaria and it contributes also to an estimated 11% of maternal mortality (WHO, 2015). There are an estimated 100 million malaria cases with over 300, 000 deaths per year in Nigeria, about 100, 000 more than the deaths from HIV/AIDS (WHO, 2015). It accounts for 60% of outpatient visits, 30% of hospitalizations among children under 5 years of age, and 11% maternal mortality (Rupashree, Jamila, Sanjay and Ukatu, 2014).
Typhoid fever, also known as typhoid, is a symptomatic bacterial infection due to Salmonella typhi (Wain, Hendriksen, Mikoleti, Keddy and Ochiai, 2015). It is largely a disease of developing nations due to their poor sanitation and poor hygiene (Wain, et al., 2015). It is spread by eating food or drinking water contaminated with faeces of an infected person (WHO, 2015). Transmission by flies such as Musca domestica has also been reported (CDC, 2007). The most prominent feature of the infection is fever (Nnabuchi and Babalola, 2008). Globally, typhoid fever is an important cause of morbidity and mortality in many regions of the world with an estimated 12-33 million cases leading to 216,000 – 600,000 deaths annually (Pang, Bhutta, Finlay and Altwegg, 2005). Co-infection of malaria and typhoid fever causes extra hardship to the health and economy of the victims.
Like malaria, there is a popular belief that typhoid fever is endemic and quite prevalent in Nigeria (Ohanu, Mbah, Okonkwo and Nwagbo, 2003; Onuigbo, 2009). Patients, who fail to respond to the first line of malaria treatment usually suspect typhoid fever (Onuigbo, 2009). Malaria and typhoid fever usually present similar symptoms particularly at the beginning of typhoid fever (Nsutebu, Ndumbe and Koulla, 2001). Owing to the fact that it is sometimes very difficult to differentiate clinically the presentation of typhoid fever from that of malaria without laboratory support (Rooth and Bjorkman, 2012), many clinicians usually request that both tests be performed on individuals presenting with fever of typhoid/malarial signs and symptoms. Co-infection with malaria and typhoid is believed to be common and therefore the simultaneous treatment of both infections is quite rampant (Mbuh, Gialadima and Ogbadu, 2003).
Like many other developing countries, accurate diagnosis of infectious diseases remains a challenge due to lack of skilled man-power and equipment making clinical diagnosis a common practice. It is therefore very important that clinical diagnosis be informed by appropriate epidemiologic data. Accurate diagnosis of a disease needs to be followed by appropriate treatment. Due to drug resistance, it is usually necessary to carry out sensitivity tests before making an informed choice of an antibiotic for treatment.
This seminar therefore dwells on the differences, signs and symptoms, diagnosis and diagnostics dilemmas, and causes of confection of malaria and typhoid This reviews the health challenges of Confection of malaria and typhoid with an objective of updating the knowledge base of Confection of malaria and typhoid for effective control among the population.

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