IngentaConnect Are intestinal helminths a risk factor for non-typhoidal Salmonel...

Authors: Dowling J.J.¹; Whitty C.J.M.²; Chaponda M.³; Munthali C.³; Zijlstra E.E.³; Gilks C.F.⁴; Squire S.B.⁴; Gordon M.A.³

Source: Annals of Tropical Medicine and Parasitology, Volume 96, Number 2, March 2002 , pp. 203-208(6)

Publisher: Maney Publishing

Abstract:

In Africa, invasive, non-typhoidal Salmonella (NTS) infections are a common but life-threatening complication in adults who are seropositive for HIV. The high prevalence of human infection with intestinal helminths which penetrate the gut could explain the greater importance of NTS bacteraemia in Africa compared with that in industrialized countries. If helminth infection is a major risk factor for NTS it would provide a locally relevant, public-health target. Intestinal helminth carriage in 57 HIV-positive patients with NTS bacteraemia (the cases) was compared with that in 162 HIV-positive controls who were similar to the cases in terms of age, sex, urban dwelling and socio-economic factors. The prevalence of helminth infection, 29% overall, was lower among the cases (18%) than among the controls (33%), giving a crude odds ratio of 0.40 [with a 95% confidence interval (CI) of 0.21-0.9] and an adjusted odds ratio (aOR) of 0.79 (CI=0.4-1.8). Five (9%) of the cases and 12 (7%) of the controls were infected with nematodes which penetrate the gut (Ascaris lumbricoides and/or Strongyloides stercoralis). The aOR for infection with these penetrating worms, corrected for age, sex, urban dwelling and phase of study, was 1.40 (CI=0.4-4.5).

The present results do not exclude the possibility that helminths play a role in invasive NTS infections, but are not consistent with helminths being a sufficient risk factor in this population to be a public-health target. Anthelmintics are unlikely to have a major impact on preventing NTS bacteraemia in patients diagnosed HIV-positive in Africa.

Document Type: Research article

DOI: 10.1179/000349802125000277

Affiliations: 1: Division of Tropical Medicine, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5AQ, U.K. 2: Department of Medicine, College of Medicine, University of Malawi, Private Bag 260, Blantyre 3, Malawi; Clinical Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, U.K. 3: Department of Medicine, College of Medicine, University of Malawi, Private Bag 260, Blantyre 3, Malawi 4: Division of Tropical Medicine, Liverpook School of Tropical Medicine, Pembroke Place, Liberpool L3 5AQ, U.K.

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Are intestinal helminths a risk factor for non-typhoidal Salmonella bacteraemia in adults in Africa who are seropositive for HIV? A case-control study