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Co-infection of malaria and typhoid in district Dir (Lower) Khyber

Pakhtunkhwa, Pakistan

Article in JOURNAL OF ENTOMOLOGY AND ZOOLOGY STUDIES · May 2017

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E-ISSN: 2320-7078
P-ISSN: 2349-6800
JEZS 2017; 5(3): 912-914
© 2017 JEZS
Received: 10-03-2017
Accepted: 11-04-2017
Muhammad Sajid
Department of Zoology, Islamia
College University, Peshawar,
Pakistan
Muhammad Zahid
Department of Zoology, Islamia
College University, Peshawar,
Pakistan
Riaz Ahmad
Department of Zoology, Islamia
College University, Peshawar,
Pakistan
Muhammad Rasool
(A). Department of Zoology,
Islamia College University,
Peshawar, Pakistan
(B). Associate Professor Govt:
Degree College Kabal Swat
Mudassar Shah
Department of Zoology, Islamia
College University, Peshawar,
Pakistan
Ikram Ullah
Department of Zoology, Islamia
College University, Peshawar,
Pakistan
Sahibzada Muhammad Jawad
Department of Zoology, Islamia
College University, Peshawar,
Pakistan
Correspondence
Muhammad Zahid
Department of Zoology, Islamia
College University, Peshawar,
Pakistan
Journal of Entomology and Zoology Studies 2017; 5(3): 912-914
Co-infection of malaria and typhoid in district Dir
(Lower) Khyber Pakhtunkhwa, Pakistan
Muhammad Sajid, Muhammad Zahid, Riaz Ahmad, Muhammad Rasool,
Mudassar Shah, Ikram Ullah and Sahibzada Muhammad Jawad
Abstract
Present study was conducted in District Head Quarter Hospital Timergara Dir (lower) to find the
coinfection of Malaria and Typhoid in the population of the area. Malaria was diagnosed by thick and
thin smears while typhoid was determined by using widal agglutination test. Highest prevalence of co
infection was observed in males that were 13(8.7%) as compared to females. The highest prevalence of
co infection in males was found in age group 16-30 that was 11.1% while in females highest prevalence
was observed in age group 46 and above that was 9.09%.
Keywords: Co-infection, malaria, typhoid, Anopheles culicifacies
1. Introduction
Malaria is the second most common disease caused by vector in Pakistan which is transmitted
by the biting of infected female mosquito of the genus Anopheles. Out of 577 species of
Anopheles which is recorded throughout the world, 77 act as a vector for malaria, 24 species of
Anopheles are known in Pakistan in which 2 species act as a vector for malaria which are
Anopheles culicifacies and Anopheles stephens [1]. Malaria is a disease of trophic caused by
Plasmodium which lives inside the red blood cells [2]. Typhoid fever is a chronic disease
caused by bacterium Salmonella typhi that is very common in many developing regions of the
world. Human is the only reservoir host of this bacterium. A person can be infected by eating
contaminated food and water [3]. Typhoid fever causes large amount of mortality and morbidity
throughout the world, it causes 27 million cases per year in which 200,000 deaths occur [4]. In
19th century the co-infection of malaria and typhoid was reported and were named by United
States army as typhomalaria. This disease was then confirmed by further studies for about 20
years in Africa and was found that large incidence of Salmonella are present with malaria [2].
Both typhoid and malaria are the diseases that are common in poor and under developed
countries. At the end of 19th century the typhomalarial theory was rejected by doing laboratory
tests and it was find out that it may be malaria or typhoid while in rare cases co infection of
Salmonella and Plasmodium also occur. In last 20 years co infection of typhoid and malaria is
also seen in Africa and India. It is clear that the causative agents of typhoid and malaria are
different that is Salmonella in case of typhoid which is a gram negative bacteria while
plasmodium in case of malaria which is a protozoan. The transmission mechanisms of both the
diseases are also different. But they share similar symptoms that lead to the confusion during
diagnosis. In last decade it was seen that in those areas where the prevalence of malaria is
high, high illness of malaria co existing with typhoid is diagnosed [5].
Symptoms of typhoid and malaria are common. Both typhoid and malaria causes significant
morbidity and mortality. Mortality rate of typhoid fever is 0.6 million per year while that of
malaria is 1-3 million per year [4]. Although the causative agent and transmission route of both
the infections are different from one another. Typhoid is transmitted by contaminated food and
water while malaria is transmitted by biting of anopheles mosquito. At 1862 the infection of
typhoid and malaria were found in American soldiers during American civil war. The patients
were suffering from febrile illness (on postmortem) with intermittent fever. They believe that
this is a hybrid which was then rejected by laboratory tests [6]. Co infection of malaria and
typhoid is the main problem in developing countries. It is more prevalent in Africa due to
poverty, contaminated water and resistance of plasmodium to antimalarial drugs. Typhoid
fever is more prevalent in those areas where resistance of malarial parasite is more to the
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Journal of Entomology and Zoology Studies

antimalarial drugs. A cross reaction between these two may Table 1: Sex wise prevalence of Co-infection of malaria and
cause a false positive widal agglutination test. And for typhoid
diagnosis of typhoid blood culture, stool culture and bone Co-
marrow culture is reliable [7]. The study is the first attempt to Sex Malaria n Typhoid n
Examined infection n
find out the prevalence of coinfection of malaria and typhoid group (%) (%)
(%)
in the area. Males 150 21(14) 9(6) 13(8.7)
Females 150 22(14.7) 7(4.7) 8(5.3)
2. Materials and Methods Total 300 44(14.7) 16(5.3) 21(7)
2.1 Study Area: This study was conducted in different
laboratories near the District headquarter hospital Timergara Table 2: Age wise prevalence of co infection of malaria and typhoid
Dir lower. Dir is a small former princely state located in in males
modern Khyber Pakhtunkhwa. Age group Examined n (%) Co-infection n (%)
1-15 40(26.7) 3(7.5)
2.2 Data Collection: The data collection was based on age, 16-30 72(48) 8(11.1)
area and sex. Nearly all the people in the data belong to the 31-45 30(20) 2(6.7)
rural areas. A total of 300 suspected samples were collected 46 and above 8(5.3) 0(0)
randomly and were tested for both malaria and typhoid. Total 150 13(8.7)

2.3 Detection Tests: Malaria was determined by microscopic
observation of parasites in a thick and thin blood film. In thin
smear the drop of the blood were spread with a clean spreader
slide on the specimen slide. While holding the spreader slide
we pushed it forward rapidly and smoothly. Thus the blood
spread on the specimen which is now fixed with methanol and
then air dried. When it became dried then we stain it with
giemsa stain while in Thick smear we used the corner of clean
slide and spread the drop of blood in a circle with diameter of
1-2 cm. Thick smear should be dried at 37 °C for 15 minutes
or, if there is no urgency, for 30 minutes to 1 hour at room
temperature and should then be exposed to acetone for 10
minutes prior to staining; a Giemsa stain can be used. Both
thick and thin blood smears were examined under the
microscope at a 1000-fold magnification. Malarial parasites
were recognizable by their physical features and by the
appearance of the red blood cells that they have infected. For
diagnosis of typhoid fever widal agglutination test [8] was used
in the study. Blood (3ml) was taken and centrifuged for 15 to
20 minutes to separate the serum. The slide was divided to 6
parts. The positive and negative control (distilled water) was
placed on separate circles on the slide. Then one drop of the
patient serum was placed on each of the four reaction circles.
The widal test antigen H was added to the both controls and a
drop of O, H, AH and BH antigens were added to the
remaining four circles already added with patient serum. The
contents were mixed and rocked for one minute for visible
agglutination reaction. In case of agglutination the test was
positive while. If no agglutination occurs the test will be
negative.
3. Results
The Co-infection data observed in 300 samples was 21(7%).
Highest prevalence was observed in males that was 13(8.7%)
while in females that prevalence of co infection was 8(5.3%)
(Table 1). The highest prevalence of co infection in males was
found in age group 16-30 that was 11.1% while in age group
46 and above there was no positive case. The prevalence in
other age groups 1-15 and 31-45 was 7.5% and 6.7%
respectively (Table 2). In a total of 150 female samples the
highest prevalence was observed in age group 46- that was
9.09% while the lowest prevalence was observed in age group
31-45 that was 2.9%. Age group 1-15 and 16-30 had 5.5%
and 5.9% prevalence of co infection of malaria and typhoid I
in females (Table 3).
Table 3: Age wise prevalence of co infection of malaria and
typhoid in females
Age group Examined n (%) Co-infection n (%)
1-15 36(24) 2(5.5)
16-30 68(45.3) 4(5.9)
31-45 35(23.3) 1(2.9)
46 and above 11(7.3) 1(9.09)
Total 150 8(5.3)
4. Discussion
The previous study that was done at Zaria showed that co
infection rate was 36.7%. The malaria patient showed ten
times more positivity to typhoid by widal test [7]. A previous
study on the prevalence of typhoid and malaria showed that
prevalence of co infection of typhoid and malaria using only
Widal test ranged from 4.4% to 70% [5]. In 107 patient of
plasmodium at Lagos, Nigeria the prevalence of co infection
of Salmonella with Plasmodium was (14.9%) that age group
0-5 contain 2 patients and other groups 6-15, 16-30, 31-45,
and above 45- year age group contain 3, 5, 4, and 2 patients
respectively that are infected with both typhoid and malaria
[8]
. Samal and Sahu described 52 patients with malaria
positive in the peripheral blood smear out of which 8 cases
were positive for typhoid [9]. Another study conducted on total
sample size of 258 individuals the prevalence of co infection
was 31% [10]. In a study Six (6) out of the 129 participants had
dual malaria and typhoid fever infections, representing 4.65%
of the total sample size [11].
The present study showed 7% prevalence of co infection of
typhoid and malaria that is less than the study of Mbuh et al
[7]
where the rate of co-infection was significantly high when
typhoid was diagnosed by Widal (10.1%) because it showed a
false positive result due to immune response stimulated by
malaria fever. The Co infection of typhoid and malaria ranges
in between 4.4%-70% by widal test [5] and the present results
was 7% which falls in the given range. High prevalence of Co
infection of Plasmodium and Salmonella than the present
study are shown bay various studies [8, 9, 10]. The different age
groups in the present study that was 1-15, 16-30, 31-45 and
above 45- have 5, 12, 3 and 1 patient respectively that showed
less prevalence than a previous study [11]. The low prevalence
of co infection may be due to a decrease number of resistivity
of plasmodium species and a low contamination of food and
water and Age group is also a reason.
Co-infection profile of Salmonella typhi and malaria parasite
was studies by using widal test and thick smear of blood 78
samples were recorded positive for typhoid 51 were positive

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Journal of Entomology and Zoology Studies

for malaria while co infection was found in 31 samples [12].
While in present study 44 samples were recorded positive for
malaria 16 for typhoid and in 21 samples co-infection was
recorded. Study that was done on Co-infection of Malaria and
Typhoid Fever in Feverish Patients in the Kumba Health
District, Southwest Cameroon: Public Health Implications at
2015 indicates that out of 78 samples 82% of samples having
malaria, 1.12% have typhoid and 6.74% having co infection
of typhoid and malaria [13]. While in present study in 300
samples 14.7% were observed for malaria 5.3% for typhoid
and 7% were observed for co infection.
5. Conclusion
Typhoid and malaria co-infection is a major public health
problem in many developing countries and were first
described as typhomalaria. In the present study it was
concluded that co-infection rate was higher in males as
compared to females while more prevalence of the coinfection
was observed in age group 16-30 years.
Co-infection in Ghana. European Journal of Experimental
Biology. 2011; 1(3):1-6.
13. Alhassan HM, Shidali NN, Manga SB, Abdullahi K,
Hamid KM. Co-infection profile of salmonella typhi and
malaria parasite in sokoto-nigeria. Global Journal of
Science, Engineering and Technology. 2012; 2(201):13-
20.
14. Ndip LM, Egbe FN, Kimbi HK, Njom HA, Ndip RN. Co-
infection of Malaria and Typhoid Fever in Feverish
Patients in the Kumba Health District, Southwest
Cameroon: Public Health Implications. International
Journal of tropical disease. 2015; 9(4):1-11.

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