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J�:"TyphoMalaria" in the hospital University of Bobo-Dioulasso, Burkina Faso.
Sangar� Ibrahim 1,2,*, Bazi� Wilfried Wenceslas 2, Sourabi� Yacouba 1,2, Sirima Constant 2, Da Fabrice 2,3, Sondo Apoline 4, Sanou Soufiane 2, Ouedraogo Abdoul Salam 1,2, Bamba Sanata 1,2, Guiguemd� Tinga Robert 1.
1 Institut Sup�rieur des Sciences de la Sant�, Universit� Nazi Boni, Bobo-Dioulasso, Burkina Faso. HYPERLINK "mailto:babaibrasangare@yahoo.fr"babaibrasangare@yahoo.fr;  HYPERLINK "mailto:yacourabie@yahoo.fr" yacourabie@yahoo.fr,  HYPERLINK "mailto:abdousal2000@yahoo.fr" abdousal2000@yahoo.fr; HYPERLINK "mailto:hsanata@yahoo.fr"hsanata@yahoo.fr; HYPERLINK "mailto:rguiguemde@yahoo.fr"rguiguemde@yahoo.fr
2 Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso. HYPERLINK "mailto:babaibrasangare@yahoo.fr"babaibrasangare@yahoo.fr;  HYPERLINK "mailto:bww_wens@yahoo.fr" bww_wens@yahoo.fr;  HYPERLINK "mailto:constantsirima@yahoo.fr" constantsirima@yahoo.fr;  HYPERLINK "mailto:domalick2000@yahoo.fr" domalick2000@yahoo.fr;  HYPERLINK "mailto:abdousal2000@yahoo.fr" abdousal2000@yahoo.fr ;  HYPERLINK "mailto:audyanour@yahoo.fr" audyanour@yahoo.fr; HYPERLINK "mailto:hsanata@yahoo.fr"hsanata@yahoo.fr
3Universit� Catholique de l'Afriques de l'Ouest, Unit� Universitaire de Bobo-Dioulasso, Burkina Faso  HYPERLINK "mailto:audyanour@yahoo.fr" audyanour@yahoo.fr 
4 Unit� de Formation en Sciences de la Sant�, Universit� Ouaga I Pr. Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.  HYPERLINK "mailto:appoli2004@yahoo.fr" appoli2004@yahoo.fr 
*Corresponding author�: Dr. SANGARE Ibrahim, PhD, Institut Sup�rieur des Sciences de la Sant�, Universit� Nazi Boni, 01 BP 1091, Bobo-Dioulasso, Burkina Faso. Phone: +226 70085167, Email:  HYPERLINK "mailto:babaibrasangare@yahoo.fr" babaibrasangare@yahoo.fr 







Abstract
Background
Malaria and typhoid fever are two endemic infectious diseases in developing tropical countries including Burkina Faso. There are two distinct infectious diseases with many similar clinical signs. In each sanitary area, it is important to describe the "typhomalaria" epidemiology to elaborate adapted diagnosis algorithm and efficient treatment protocol.
Objectives
Our study aimed to analyze the epidemiological profile of malaria and salmonellosis coinfection named "typhomalaria" in Hospital University of Bobo-Dioulasso, Burkina Faso.
Methods
A cross-sectional prospective study was carried out from July to October 2014 in the lab department of University Hospital Souro SANOU of Bobo-Dioulasso, Burkina Faso. All positive Plasmodium sp. cases diagnosis by microscopy were included after their consent. All microscopy positive malaria during study period was included. Serodiagnosis of Widal and Felix was performed systematically on all Plasmodium sp malaria cases. Titers of antibodies anti-agglutinin O equal or higher than 1/400 and/or 1/800 for anti-agglutinin H antibodies were considered positive for Salmonella sp.
Results
A total of 283 malaria cases were included in this study, majority falciparum malaria. In this malaria cases, 91 patients were seropositive for Salmonella sp. "Typhomalaria" co-infection prevalence was 34.3% (CI 95% [28.8%; 40.1%]). The patient with the normal hemoglobin rate had the high prevalence of coinfection (46.7% versus 30.9; p=0.02).
Conclusions
Malaria and typhoid fever co-infection was high (approximately 1/3 of malaria cases) in University hospital of Bobo-Dioulasso. This study revealed the need to explore typhoid fever in malaria confirmed cases, especially in persistent fevers and non-anemia situation despite adapted antimalarial treatment.
Keywords: Malaria, Typhoid fever, Coinfection, Burkina Faso, University Hospital.INTRODUCTION
Malaria and typhoid fever (TF) are the endemic infectious diseases in tropical areas. Both diseases have been considered as poverty related diseases and cause high morbidity and mortality mainly in sub-Saharan Africa ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0972-9062", "ISSN" : "09729062", "PMID" : "18592842", "abstract" : "BACKGROUND & OBJECTIVES: Malaria and typhoid fever still remain diseases of major public health importance in the tropics. Individuals in areas endemic for both the diseases are at substantial risk of contracting both these diseases, either concurrently or an acute infection superimposed on a chronic one. The objective of this report was to systematically review scientific data from studies conducted in the tropics on concurrent malaria and typhoid fever within the last two decades (1987-2007), to highlight the diagnostic challenges and the public health implications. METHODS: Using the MedLine Entrez-PubMed search, relevant publications were identified for the review via the key words Malaria and Typhoid fever, which yielded 287 entries as of January 2008. RESULTS: Most of the studies reviewed expressed concern that poor diagnosis continues to hinder effective control of concurrent malaria and typhoid fever in the tropics due to: non-specific clinical presentation of the diseases; high prevalence of asymptomatic infections; lack of resources and insufficient access to trained health care providers and facilities; and widespread practice of self-treatment for clinically suspected malaria or typhoid fever. INTERPRETATION & CONCLUSION: There were considerably higher rates of concurrent malaria and typhoid fever by Widal test compared to the bacteriological culture technique. Although culture technique remains the gold standard in typhoid fever diagnosis, Widal test is still of significant diagnostic value provided judicious interpretation of the test is made against a background of pertinent information. Malaria could be controlled through interventions to minimize human-vector contact, while improved personal hygiene, targeted vaccination campaigns and intensive community health education could help to control typhoid fever in the tropics.", "author" : [ { "dropping-particle" : "", "family" : "Uneke", "given" : "C. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Vector Borne Diseases", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "133-142", "title" : "Concurrent malaria and typhoid fever in the tropics: The diagnostic challenges and public health implications", "type" : "article-journal", "volume" : "45" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=bd38667b-4942-4779-acf2-35de520396ab" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.ijpara.2010.08.005", "ISBN" : "0020-7519", "ISSN" : "1879-0135", "PMID" : "20833173", "abstract" : "The malaria burden in Viet Nam has been in decline in recent decades, but localised areas of high transmission remain. We used spatiotemporal analytical tools to determine the social and environmental drivers of malaria risk and to identify residual high-risk areas where control and surveillance resources can be targeted. Counts of reported Plasmodium falciparum and Plasmodium vivax malaria cases by month (January 2007-December 2008) and by district were assembled. Zero-inflated Poisson regression models were developed in a bayesian framework. Models had the percentage of the district's population living below the poverty line, percent of the district covered by forest, median elevation, median long-term average precipitation, and minimum temperature included as fixed effects, and terms for temporal trend and residual district-level spatial autocorrelation. Strong temporal and spatial heterogeneity in counts of malaria cases was apparent. Poverty and forest cover were significantly associated with an increased count of malaria cases but the magnitude and direction of associations between climate and malaria varied by socio-ecological zone. There was a declining trend in counts of malaria cases during the study period. After accounting for the social and environmental fixed effects, substantial spatial heterogeneity was still evident. Unmeasured factors which may contribute to this residual variation include malaria control activities, population migration and accessibility to health care. Forest-related activities and factors encompassed by poverty indicators are major drivers of malaria incidence in Viet Nam.", "author" : [ { "dropping-particle" : "", "family" : "Bui", "given" : "H Manh", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clements", "given" : "Archie C A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nguyen", "given" : "Q Thieu", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nguyen", "given" : "M Hung", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Le", "given" : "X Hung", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hay", "given" : "Simon I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tran", "given" : "T Hien", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wertheim", "given" : "Heiman F L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Snow", "given" : "Robert W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Horby", "given" : "Peter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International journal for parasitology", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "109-16", "title" : "Social and environmental determinants of malaria in space and time in Viet Nam.", "type" : "article-journal", "volume" : "41" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=1cecd231-a44a-4323-b468-8f756b6be90f" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1007/1-4020-3870-4_8", "ISBN" : "1402029020", "ISSN" : "13873547", "abstract" : "An Asiatic mosquito species, Aedes albopictus, began to spread worldwide in the 1970s thanks to marine transport of tires and other goods, leading to colonization of many areas of the world. This species is a vector of major human diseases such as Dengue, Yellow Fever and the West Nile virus. In Europe, it was established in Albania and Italy and has been detected in other countries such as France; no records exist for Spain as yet. Colonization by Aedes albopictus is a major public health concern considering that the West Nile virus and several other viruses are known to circulate sporadically in the Mediterranean. Additionally, the parent species Aedes aegypti was the vector causing severe outbreaks of Dengue and Yellow Fever two centuries ago. Although Ae. aegypti was also introduced, it was eradicated from Spain. Both mosquitoes shared habitat types, diseases transmitted and many bionomic data. This article contains a review of the present Ae. albopictus distribution range worldwide and discusses the likelihood of an establishment in Spain in view of climatological and geographical data..", "author" : [ { "dropping-particle" : "", "family" : "Eritja", "given" : "Roger", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Escosa", "given" : "Ra\u00fal", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lucientes", "given" : "Javier", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Marqu\u00e8s", "given" : "Eduard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Molina", "given" : "Ricardo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Roiz", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ruiz", "given" : "Santiago", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Issues in Bioinvasion Science: EEI 2003: A Contribution to the Knowledge on Invasive Alien Species", "id" : "ITEM-3", "issued" : { "date-parts" : [ [ "2005" ] ] }, "page" : "87-97", "title" : "Worldwide invasion of vector mosquitoes: Present European distribution and challenges for Spain", "type" : "chapter" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=53608e7a-4bbe-4c89-a7c8-4a14d87dbe5e" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1186/s40249-016-0164-3", "ISBN" : "4024901601643", "ISSN" : "2049-9957", "PMID" : "27488674", "abstract" : "BACKGROUND: Malaria control and sustainable development are linked, but implementation of 'multisectoral' intervention is restricted by a limited understanding of the causal pathways between poverty and malaria. We investigated the relationships between socioeconomic position (SEP), potential determinants of SEP, and malaria in Nagongera, rural Uganda. METHODS: Socioeconomic information was collected for 318 children aged six months to 10 years living in 100 households, who were followed for up to 36 months. Mosquito density was recorded using monthly light trap collections. Parasite prevalence was measured routinely every three months and malaria incidence determined by passive case detection. First, we evaluated the association between success in smallholder agriculture (the primary livelihood source) and SEP. Second, we explored socioeconomic risk factors for human biting rate (HBR), parasite prevalence and incidence of clinical malaria, and spatial clustering of socioeconomic variables. Third, we investigated the role of selected factors in mediating the association between SEP and malaria. RESULTS: Relative agricultural success was associated with higher SEP. In turn, high SEP was associated with lower HBR (highest versus lowest wealth index tertile: Incidence Rate Ratio 0.71, 95 % confidence intervals (CI) 0.54-0.93, P = 0.01) and lower odds of malaria infection in children (highest versus lowest wealth index tertile: adjusted Odds Ratio 0.52, 95 % CI 0.35-0.78, P = 0.001), but SEP was not associated with clinical malaria incidence. Mediation analysis suggested that part of the total effect of SEP on malaria infection risk was explained by house type (24.9 %, 95 % CI 15.8-58.6 %) and food security (18.6 %, 95 % CI 11.6-48.3 %); however, the assumptions of the mediation analysis may not have been fully met. CONCLUSION: Housing improvements and agricultural development interventions to reduce poverty merit further investigation as multisectoral interventions against malaria. Further interdisplinary research is needed to understand fully the complex pathways between poverty and malaria and to develop strategies for sustainable malaria control.", "author" : [ { "dropping-particle" : "", "family" : "Tusting", "given" : "Lucy S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rek", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arinaitwe", "given" : "Emmanuel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Staedke", "given" : "Sarah G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamya", "given" : "Moses R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cano", "given" : "Jorge", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bottomley", "given" : "Christian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Johnston", "given" : "Deborah", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dorsey", "given" : "Grant", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lindsay", "given" : "Steve W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lines", "given" : "Jo", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Infectious Diseases of Poverty", "id" : "ITEM-4", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "1-11", "title" : "Why is malaria associated with poverty ? Findings from a cohort study in rural Uganda", "type" : "article-journal" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=15d1ba5a-aa1c-4f26-a5de-5d5e8bab9f31" ] } ], "mendeley" : { "formattedCitation" : "<sup>1\u20134</sup>", "plainTextFormattedCitation" : "1\u20134", "previouslyFormattedCitation" : "(1\u20134)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }1�4. Malaria and TF coinfection has been described in the medical literature in the mid-19th century and named "typhomalaria" ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "http://dx.doi.org/10.1016/S0140-6736(02)11343-2", "author" : [ { "dropping-particle" : "", "family" : "Bill", "given" : "Bynum", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Lancet", "id" : "ITEM-1", "issue" : "9342", "issued" : { "date-parts" : [ [ "2002" ] ] }, "page" : "1339", "title" : "Typhomalaria", "type" : "article-journal", "volume" : "360" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5934a987-98c9-449d-a66f-649b5a7558c1" ] } ], "mendeley" : { "formattedCitation" : "<sup>5</sup>", "plainTextFormattedCitation" : "5", "previouslyFormattedCitation" : "(5)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }5.
Malaria and TF, whose clinical sign dominating is the fever, are due to two distinct pathogens, with different transmission modes. In fact, human malaria is causes by 5 haematozoa parasite species, Plasmodium genus and transmitted actively by Anopheles female mosquito infecting bite. Salmonella TF is due to invasive enteric bacteria, Salmonella genus and transmitted through oral route consuming water and food contaminated by infected faeces. Thus, malaria is vector borne diseases and TF food borne diseases.
Although TF and malaria are caused by distinct microorganisms (Gram-negative bacillus versus hematozoa protozoan parasite for malaria) and transmitted via different mechanisms. The two diseases have many similar clinical signs such fever, headache and abdominal pain ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0972-9062", "ISSN" : "09729062", "PMID" : "18592842", "abstract" : "BACKGROUND & OBJECTIVES: Malaria and typhoid fever still remain diseases of major public health importance in the tropics. Individuals in areas endemic for both the diseases are at substantial risk of contracting both these diseases, either concurrently or an acute infection superimposed on a chronic one. The objective of this report was to systematically review scientific data from studies conducted in the tropics on concurrent malaria and typhoid fever within the last two decades (1987-2007), to highlight the diagnostic challenges and the public health implications. METHODS: Using the MedLine Entrez-PubMed search, relevant publications were identified for the review via the key words Malaria and Typhoid fever, which yielded 287 entries as of January 2008. RESULTS: Most of the studies reviewed expressed concern that poor diagnosis continues to hinder effective control of concurrent malaria and typhoid fever in the tropics due to: non-specific clinical presentation of the diseases; high prevalence of asymptomatic infections; lack of resources and insufficient access to trained health care providers and facilities; and widespread practice of self-treatment for clinically suspected malaria or typhoid fever. INTERPRETATION & CONCLUSION: There were considerably higher rates of concurrent malaria and typhoid fever by Widal test compared to the bacteriological culture technique. Although culture technique remains the gold standard in typhoid fever diagnosis, Widal test is still of significant diagnostic value provided judicious interpretation of the test is made against a background of pertinent information. Malaria could be controlled through interventions to minimize human-vector contact, while improved personal hygiene, targeted vaccination campaigns and intensive community health education could help to control typhoid fever in the tropics.", "author" : [ { "dropping-particle" : "", "family" : "Uneke", "given" : "C. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Vector Borne Diseases", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "133-142", "title" : "Concurrent malaria and typhoid fever in the tropics: The diagnostic challenges and public health implications", "type" : "article-journal", "volume" : "45" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=bd38667b-4942-4779-acf2-35de520396ab" ] } ], "mendeley" : { "formattedCitation" : "<sup>1</sup>", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "(1)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }1. Differential diagnosis between malaria and TF are essential for treatment and co-infection care management is a challenge for clinician. 
In the biological profile, previous study has reported a false positive malaria rapid diagnostic test (RDT) (BinaxNOW� malaria) result for P. falciparum in Salmonella typhi bacteremia case without rheumatoid or autoimmune factors due to immunological disorder ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1471-2334-14-377", "ISBN" : "1471-2334", "PMID" : "25005493", "abstract" : "BACKGROUND: Rapid diagnostic tests play a pivotal role in the early diagnosis of malaria where microscopy or polymerase chain reaction are not immediately available. CASE PRESENTATION: We report the case of a 39 year old traveler to Canada who presented with fever, headache, and abdominal pain after visiting friends and relatives in India. While in India, the individual was not ill and had no signs or symptoms of malaria. Laboratory testing upon his return to Canada identified a false positive malaria rapid diagnostic (BinaxNOW malaria) result for P. falciparum with coincident Salmonella Typhi bacteraemia without rheumatoid or autoimmune factors. Rapid diagnostic test false positivity for malaria coincided with the presence or absence of Salmonella Typhi in the blood. CONCLUSIONS: Clinicians should be aware that Salmonella Typhi infection may result in a false positive malaria rapid diagnostic test. The mechanism of this cross-reactivity is not clear.", "author" : [ { "dropping-particle" : "", "family" : "Meatherall", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Preston", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pillai", "given" : "D R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMC Infectious Diseases", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "377", "title" : "False positive malaria rapid diagnostic test in returning traveler with typhoid fever", "type" : "article-journal", "volume" : "14" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6d568d31-2fd1-463c-ae78-cb5a04705051" ] } ], "mendeley" : { "formattedCitation" : "<sup>6</sup>", "plainTextFormattedCitation" : "6", "previouslyFormattedCitation" : "(6)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }6. In addition, it was also reported that Plasmodium infections increase Salmonella spp infection susceptibility ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.3923/jbs.2011.367.373", "ISBN" : "1727-3048\\r1812-5719", "ISSN" : "17273048", "PMID" : "2011629469", "abstract" : "There has been high incidence of malaria and typhoid co-infection in Nigeria lately but no documented study has really considered its impact on the biochemical status of the patients. The aim of this study was to investigate the effect of malaria and malaria-typhoid co-infection on some hematological and biochemical parameters in infected patients. A total of 66 febrile patients and 10 apparently healthy persons from Bells University of Technology and Covenant University Health Centers, Ota, Ogun State were screened for the presence of plasmodium falciparum and salmonella typhi. Levels of Neutrophils, Lymphocytes, White Blood Cells, Packed Cell Volume (PCV), Albumin, Urea, Glucose, Total Bilirubin, Total Protein and Creatinine were estimated in the blood plasma of the study groups. A significant increase (p<0.05) in Creatinine, Urea and Total Bilirubin levels, Neutrophils and White Blood Cell counts were observed in both the malaria and co-infected patients as compared to the control. However, Albumin, Glucose, PCV, Lymphocytes and Total Protein levels were significantly reduced (p<0.05) in both the malaria and co-infected patients. This study indicates alterations in these parameters and therefore recommends proper monitoring during treatment in order to reverse them to normal levels. \u00a9 2011 Asian Network for Scientific Information.", "author" : [ { "dropping-particle" : "", "family" : "Kayode", "given" : "O. T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kayode", "given" : "A. A A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Awonuga", "given" : "O. O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Biological Sciences", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "367-373", "title" : "Status of selected hematological and biochemical parameters in malaria and malaria-typhoid co-infection", "type" : "article-journal", "volume" : "11" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=9c2ffc32-6e80-41a2-b84e-f66902d58497" ] } ], "mendeley" : { "formattedCitation" : "<sup>7</sup>", "plainTextFormattedCitation" : "7", "previouslyFormattedCitation" : "(7)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }7. In fact, haemolysis during malaria, releases heme oxygenase, which is an enzyme that demobilizes the granulocytes involved in anti-Salmonella cellular immunity.
In Africa, few epidemiology studies have shown that the prevalence of "typhomalaria" is not negligible. In Ethiopia, 6.5% of prevalence was reported ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "http://dx.doi.org/10.1155/2014/531074", "ISSN" : "2356-6752", "PMID" : "26556415", "abstract" : "Background. Malaria and typhoid fever are major public health problems in tropical and subtropical countries. People in endemic areas are at risk of contracting both infections concurrently. Objectives. The study was aimed at determining the prevalence and associated risk factors of malaria, typhoid, and their coinfection among febrile patients. Methods. A cross-sectional study was conducted on 200 febrile patients suspected for malaria and/or typhoid fever from April to May, 2013, at Ayinba Health Center, Northwest Ethiopia. Blood samples were collected for blood culture, Widal test, and blood film preparation. Data were analyzed using SPSS version 20 statistical software. Results. The prevalence of malaria was 36.5% (n = 73). Among these 32 (43.8%), 30 (41.1%) and 11 (15.1%) were positive for P. falciparum, P. vivax, and mixed infections, respectively. The seroprevalence of typhoid fever was 38 (19%), but 1 (0.5%) with blood culture. Malaria typhoid fever coinfection was 13 (6.5%). 2-5-year-old children and poor hand washing habit were significantly associated with malaria and typhoid infection, respectively (P < 0.05). Conclusions. The prevalence of malaria and typhoid fever was found high. Further studies should be done on the other determinants of malaria and typhoid fever coinfection in different seasons and different study areas.", "author" : [ { "dropping-particle" : "", "family" : "Birhanie", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tessema", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ferede", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Endris", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Enawgaw", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Advances in Medicine Print", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "531074", "title" : "Malaria, Typhoid Fever, and Their Coinfection among Febrile Patients at a Rural Health Center in Northwest Ethiopia: A Cross-Sectional Study", "type" : "article-journal", "volume" : "2014" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=8a5c7829-5183-4663-8162-62238055f22f" ] } ], "mendeley" : { "formattedCitation" : "<sup>8</sup>", "plainTextFormattedCitation" : "8", "previouslyFormattedCitation" : "(8)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }8 and 5% to 40% in Nigeria ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.3923/jbs.2011.367.373", "ISBN" : "1727-3048\\r1812-5719", "ISSN" : "17273048", "PMID" : "2011629469", "abstract" : "There has been high incidence of malaria and typhoid co-infection in Nigeria lately but no documented study has really considered its impact on the biochemical status of the patients. The aim of this study was to investigate the effect of malaria and malaria-typhoid co-infection on some hematological and biochemical parameters in infected patients. A total of 66 febrile patients and 10 apparently healthy persons from Bells University of Technology and Covenant University Health Centers, Ota, Ogun State were screened for the presence of plasmodium falciparum and salmonella typhi. Levels of Neutrophils, Lymphocytes, White Blood Cells, Packed Cell Volume (PCV), Albumin, Urea, Glucose, Total Bilirubin, Total Protein and Creatinine were estimated in the blood plasma of the study groups. A significant increase (p<0.05) in Creatinine, Urea and Total Bilirubin levels, Neutrophils and White Blood Cell counts were observed in both the malaria and co-infected patients as compared to the control. However, Albumin, Glucose, PCV, Lymphocytes and Total Protein levels were significantly reduced (p<0.05) in both the malaria and co-infected patients. This study indicates alterations in these parameters and therefore recommends proper monitoring during treatment in order to reverse them to normal levels. \u00a9 2011 Asian Network for Scientific Information.", "author" : [ { "dropping-particle" : "", "family" : "Kayode", "given" : "O. T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kayode", "given" : "A. A A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Awonuga", "given" : "O. O.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Biological Sciences", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "367-373", "title" : "Status of selected hematological and biochemical parameters in malaria and malaria-typhoid co-infection", "type" : "article-journal", "volume" : "11" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=9c2ffc32-6e80-41a2-b84e-f66902d58497" ] }, { "id" : "ITEM-2", "itemData" : { "ISBN" : "0976-1233", "PMID" : "20113163812", "abstract" : "Malaria and typhoid fevers have become a major scourge afflicting people in most developing and tropical countries of the world. Malaria and typhoid fevers often have similar symptoms and therefore require careful and accurate laboratory diagnosis for effective treatment of patients. A total of 75 patients and 25 healthy persons attending Irrua Specialist Teaching Hospital, Irrua, Edo state, Nigeria were screened for malaria parasites (using the Giemsa staining technique and microscopy for parasites) and were evaluated for the presence of Widal agglutinins. Using the Cromatest Widal test kits (Linear Chemicals, Spain), slide and tube agglutination tests were performed. Overall, 39% seropositivity was recorded; 20(51.2%) were males, while 19 (48.7%) were females of these, 5% were positive for malaria parasites. Salmonella typhi infection was the most common. There was low co-infection with Salmonella spp. and malaria parasites among patients; ( chi <sup>2</sup>=2.743, P>0.05). Salmonella typhi appears to be the most prevalent species infecting people in Esan land.", "author" : [ { "dropping-particle" : "", "family" : "Isibor", "given" : "J O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Igun", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Okodua", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Akhile", "given" : "A O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Isibor", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Adagbonyi", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Annals of Biological Research", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "361-365", "title" : "Co-infection with malaria parasites and Salmonella typhi in patients in Benin City, Nigeria", "type" : "article-journal", "volume" : "2" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=fcaf9d10-25d0-4d36-854b-5b4c0e2021ae" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.5897/AJB10.1694", "ISBN" : "1684-5315", "ISSN" : "16845315", "PMID" : "20113124442", "abstract" : "Mixed infection of malaria caused by Plasmodium species and typhoid fever caused by Salmonella species is often observed in areas where malaria is endemic, and the infection with Salmonella species has been considered by some medical and non-medical personnels to be associated with the malaria parasite infection. Based on this reason, many medical personnel treat both malaria and typhoid simultaneously in every case of suspected Salmonella infection and vice versa. In this study, the association between malaria and typhoid infections was investigated. Twenty five malaria patients were screened for antibody against Salmonella species using widal test. The stool and blood samples of the patients were also screened for possible isolation of Salmonella species. Of the 25 subjects, 23 (92%) had positive antibody titre (>= 1/80) for Salmonella paratyphi A, 11 (44%) were positive for S. paratyphi B, 8 (32%) were positive for S. paratyphi C, while 5 (20%) were positive for Salmonella typhi. Salmonella species were isolated from stool samples of 13 subjects, but only 3 subjects had Salmonella species in their blood samples. The results indicated that there is no relationship between malaria and Salmonella infection, but there was a significant (p < 0.01) association between S. typhi, S. paratyphi B and S. paratyphi C infections. The results also showed a significant (p < 0.05) relationship between Salmonella in stool and its appearance in blood, suggesting that the presence of Salmonella in blood is indicative of its presence in stool.", "author" : [ { "dropping-particle" : "", "family" : "Eze", "given" : "E A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ukwah", "given" : "B N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Okafor", "given" : "P C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ugwu", "given" : "K O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "African Journal of Biotechnology", "id" : "ITEM-3", "issue" : "11", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "2135-2143", "title" : "Prevalence of malaria and typhoid co-infections in University of Nigeria, Nsukka District of Enugu State, Nigeria", "type" : "article-journal", "volume" : "10" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2702c298-4e4e-4493-8cbe-40ec0e7ffb7e" ] } ], "mendeley" : { "formattedCitation" : "<sup>7,9,10</sup>", "plainTextFormattedCitation" : "7,9,10", "previouslyFormattedCitation" : "(7,9,10)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }7,9,10. In Burkina Faso, to our best knowledge, no data on "typhomalaria" was published. We performed this study to analyze the epidemiological profile of co-infection malaria-typhoid fever at the University Hospital Sour� SANOU of Bobo-Dioulasso.

METHODS
Study design 
A cross-sectional prospective study was carried out from July to October 2014 in the lab department of University Hospital Souro SANOU of Bobo-Dioulasso, Burkina Faso. All positive Plasmodium sp. cases diagnosis by microscopy were included after their consent. In a brief interview with the patient or legal guardian for children, we have explained the aim of the additional medical analyzes. Three to four milliliter of venous blood was collected in anticoagulant EDTA tubes and non-anticoagulant tubes. Patient age, sex and clinical informations were registered on the data collection sheet.
Malaria diagnosis
Microscopy technique was used to diagnosis malaria case. Thick and thin blood film were performed from anticoagulant EDTA venous blood, stained with Giemsa 10% solution and were examined by microscopy.
Salmonella Typhoid Fever diagnosis
Serodiagnosis test of Widal and Felix (SDWF) was performed on the plasma after non-anticoagulant venous blood centrifugation according to the manufacturer's instructions of Febrile Antigens Widal (Quimica Clinican Aplicada S.A., Spain). It is an antigen-antibody agglutination test for Salmonella sp O and H agglutinins detection. Titers of anti-agglutinin O antibodies equal or higher than 1:400 and / or 1:800 for anti-agglutinin H antibodies after plasma dilution using saline water 0.9% were considered positive for Salmonella sp.
Data analysis 
Data were double entered based on EpiData 3.1. Statistical analysis was performed with SPSS Statistics 17.0 (SPSS Inc., Chicago, IL). Chi-square test was used to compare the categorical variables. Fisher�s exact test was used when the expected value in any cell was less than 5. The tests were considered significant with p value inferior to 0.05. For analytical purposes, the study participants were subdivided into the age group according to the risk of infection with salmonellosis (autonomy to ensure food hygiene by itself) and malaria. For blood parameters, the following definition have been used: anemia is defined by the hemoglobin rate inferior and/or equal to 11 g/dL; leukocytosis by the number of WBC superior and/or equal to 11000/dL; leukopenia by the number of WBC inferior and/or equal to 4000/dL; eosinophilia by the number of eosinophil superior and/or equal to 500/dL; neutrophilia by the number of neutrophil superior and/or equal to 8000/dL and neutropenia by the number of neutrophil inferior and/or equal to 1500/dL.

Ethics statement 
Included patients have given consent and their parents or legal guardian for minors before. Personal data form and all diagnostic results were kept strictly confidential. Results of participants with parasitic infections were sent as soon as possible to clinicians for care management. 
RESULTS
Characteristics of the study population
From July to October 2014, 283 malaria cases were diagnosis in our laboratory and have been included.
Among the 283 patients, 49.5% were male and 50.5% were female. The mean age of the participants was 21.8 years and the median 18 years (ranged 0�85 years). 
The prevalence of anemia was 78.8%. Leukocytosis was found in 36.4% of participants and 25.4% had neutropenia (Table 1).
Parasitological results
Plasmodium falciparum was the most species found (98.9%). Tree cases of P. malaria were diagnosis (1.1%). The parasitemia geometric mean was 549.2 ranged between 8 to 1000000
Prevalence of co-infection Malaria and typhoid fever
The SDWF test were positive for agglutinins O and/or H in 97 patients. Thus, the coinfection prevalence was 34.3%, IC95% [28.8; 40.1%]. The prevalence of coinfection increase with age but the association was not statiscally significant (p=0.23) as reported in table2. The patient with the normal hemoglobin rate had the high prevalence of coinfection (46.7%; p=0.02) (Table 2). The WBC parameters were not associated to coinfection.

DISCUSSION
Malaria and typhoid fever are major public health problem in sub-Saharan African countries including Burkina Faso. Here, we analyzed epidemiology of concomitant infection of these two diseases.
The prevalence of "typhomalaria" was high (34.28%). Similar prevalence has been found in Cameroon (32.5%) and in Nigeria (20-40%) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.5897/AJB10.1694", "ISBN" : "1684-5315", "ISSN" : "16845315", "PMID" : "20113124442", "abstract" : "Mixed infection of malaria caused by Plasmodium species and typhoid fever caused by Salmonella species is often observed in areas where malaria is endemic, and the infection with Salmonella species has been considered by some medical and non-medical personnels to be associated with the malaria parasite infection. Based on this reason, many medical personnel treat both malaria and typhoid simultaneously in every case of suspected Salmonella infection and vice versa. In this study, the association between malaria and typhoid infections was investigated. Twenty five malaria patients were screened for antibody against Salmonella species using widal test. 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While the high prevalence of malaria is an established fact, it is only within the past 5 years that an unusually high number of illnesses have been diagnosed as malaria co-existing with typhoid fever. The Widal test is widely used as the sole laboratory test for the diagnosis of typhoid fever. To investigate the extent of the malaria and typhoid fever association, we used blood and stool cultures as additional diagnostic tests for typhoid fever. We report that, of 200 patients presenting with fever, 17.0% had concurrent malaria and typhoid fever (Salmonella typhi) based on bacteriological proven diagnosis as compared with 47.9% based on the Widal test. A higher proportion of patients (32.5%) had malaria coexisting with S. typhimurium when compared to S. paratyphi (2%) and S. typhi (P < 0.05). We conclude that the number of fever cases diagnosed as malaria co-existing with typhoid fever is overestimated.", "author" : [ { "dropping-particle" : "", "family" : "Ammah", "given" : "Adolf", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nkuo-Akenji", "given" : "Theresa", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ndip", "given" : "Roland", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Deas", "given" : "J. 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The peak of malaria transmission in Burkina Faso was September to October ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1603/ME09102", "ISBN" : "0022-2585 (Print)\\r0022-2585 (Linking)", "ISSN" : "0022-2585", "PMID" : "20695277", "abstract" : "To determine the relationship between malaria transmission intensity, clinical malaria, immune response, plasmodic index, and to furthermore characterize a malaria vaccine trial site for potential malaria vaccines candidate testing, a study was conducted in Tensobtenga and Balonguen, two villages in Burkina Faso characterized by different malaria transmission levels. The study villages are located in a Sudan savanna area. Malaria transmission is seasonal and peaks in September in these villages. Tensobtenga and Balonguen are comparables in all aspects, except the presence of an artificial lake and wetlands in Tensobtenga. The mosquitoes sampling sites were randomly selected, taking into consideration the number of potential breeding sites, and the number of households in each village. Three times a week during 12 mo mosquitoes were collected by the Center for Disease Control and Prevention light traps in sentinel sites. To assess the infectivity the mosquitoes double ELISAs tests were performed on thoraces of female Anopheles gambiae s.l. (Giles) and Anopheles funestus. A total of 54,392 female Anopheles, representing 92.71% of the total mosquitoes, were collected. The peaks of aggressiveness because of either An. gambiae s.l. or An. funestus were observed in September in each of the villages. However, these peaks were lower in Balonguen compared with Tensobtenga. Malaria cumulative aggressiveness and transmission intensity because of both species peaked in September in each of the two villages, with lower values in Balonguen in comparison to Tensobtenga From February to May, malaria transmission intensity is negligible in Balonguen and <1 bite/person/mo is observed in Tensobtenga. These results have confirmed the marked seasonality of malaria transmission in the study area.", "author" : [ { "dropping-particle" : "", "family" : "Ilboudo-Sanogo", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tiono", "given" : "B A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sagnon", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cuzin Ouattara", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nebie", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sirima", "given" : "S B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "J Med Entomol", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "618-624", "title" : "Temporal dynamics of malaria transmission in two rural areas of Burkina Faso with two ecological differences", "type" : "article-journal", "volume" : "47" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=642584fb-6b86-4ac2-a04c-ad26386d8e18" ] } ], "mendeley" : { "formattedCitation" : "<sup>12</sup>", "plainTextFormattedCitation" : "12", "previouslyFormattedCitation" : "(12)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }12. In addition many studies have indicated that the high prevalence of TF during rainy seasons ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1371/journal.pntd.0004212", "ISBN" : "10.1371/journal.pntd.0004212", "ISSN" : "19352735", "PMID" : "26633656", "abstract" : "BACKGROUND: Enteric fever due to Salmonella Typhi (typhoid fever) occurs in urban areas with poor sanitation. While direct fecal-oral transmission is thought to be the predominant mode of transmission, recent evidence suggests that indirect environmental transmission may also contribute to disease spread.\\n\\nMETHODS: Data from a population-based infectious disease surveillance system (28,000 individuals followed biweekly) were used to map the spatial pattern of typhoid fever in Kibera, an urban informal settlement in Nairobi Kenya, between 2010-2011. 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The coinfection increased with age but the difference between the age groups was not significant (p = 0.32). Identic observations had been in Nigeria 9-ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1371/journal.pntd.0004212", "ISBN" : "10.1371/journal.pntd.0004212", "ISSN" : "19352735", "PMID" : "26633656", "abstract" : "BACKGROUND: Enteric fever due to Salmonella Typhi (typhoid fever) occurs in urban areas with poor sanitation. While direct fecal-oral transmission is thought to be the predominant mode of transmission, recent evidence suggests that indirect environmental transmission may also contribute to disease spread.\\n\\nMETHODS: Data from a population-based infectious disease surveillance system (28,000 individuals followed biweekly) were used to map the spatial pattern of typhoid fever in Kibera, an urban informal settlement in Nairobi Kenya, between 2010-2011. 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This result could be explained by the eating behavior. Usually, in our developing countries, adults eat in public restaurants where hygiene can be lacking ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Drabo", "given" : "KM", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Toe", "given" : "LP", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Savadogo", "given" : "LG", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tarnagda", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zeba", "given" : "AN", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zongo", "given" : "I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rouamba", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Toe", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ou\u00e9draogo", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ou\u00e9draogo", "given" : "JB", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Bull Soc Pathol Exot.", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "36-40", "title" : "Main characteristics of the street food sector in Bobo-Dioulasso, Burkina Faso", "type" : "article-journal", "volume" : "102" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6e5eab58-ef64-4fbe-9a77-b8ae9788d2d6" ] } ], "mendeley" : { "formattedCitation" : "<sup>14</sup>", "plainTextFormattedCitation" : "14", "previouslyFormattedCitation" : "(14)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }14.
Any association was not found between male and female concerning "typhomalaria (p = 0.46). However, the "typhomalaria" prevalence was higher in women according with one study in Ethiopia ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "http://dx.doi.org/10.1155/2014/531074", "ISSN" : "2356-6752", "PMID" : "26556415", "abstract" : "Background. Malaria and typhoid fever are major public health problems in tropical and subtropical countries. People in endemic areas are at risk of contracting both infections concurrently. Objectives. The study was aimed at determining the prevalence and associated risk factors of malaria, typhoid, and their coinfection among febrile patients. Methods. A cross-sectional study was conducted on 200 febrile patients suspected for malaria and/or typhoid fever from April to May, 2013, at Ayinba Health Center, Northwest Ethiopia. Blood samples were collected for blood culture, Widal test, and blood film preparation. Data were analyzed using SPSS version 20 statistical software. Results. The prevalence of malaria was 36.5% (n = 73). Among these 32 (43.8%), 30 (41.1%) and 11 (15.1%) were positive for P. falciparum, P. vivax, and mixed infections, respectively. The seroprevalence of typhoid fever was 38 (19%), but 1 (0.5%) with blood culture. Malaria typhoid fever coinfection was 13 (6.5%). 2-5-year-old children and poor hand washing habit were significantly associated with malaria and typhoid infection, respectively (P < 0.05). Conclusions. The prevalence of malaria and typhoid fever was found high. Further studies should be done on the other determinants of malaria and typhoid fever coinfection in different seasons and different study areas.", "author" : [ { "dropping-particle" : "", "family" : "Birhanie", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tessema", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ferede", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Endris", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Enawgaw", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Advances in Medicine Print", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "531074", "title" : "Malaria, Typhoid Fever, and Their Coinfection among Febrile Patients at a Rural Health Center in Northwest Ethiopia: A Cross-Sectional Study", "type" : "article-journal", "volume" : "2014" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=8a5c7829-5183-4663-8162-62238055f22f" ] } ], "mendeley" : { "formattedCitation" : "<sup>8</sup>", "plainTextFormattedCitation" : "8", "previouslyFormattedCitation" : "(8)" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }8. Thus, women could be contaminated by Salmonella during food preparation and other maternal activities such childcare.
Concerning blood parameters, hemoglobin rate was significant associated coinfection with the high prevalence in non-anemia patient compared to anemia patient. The lack of anemia in malaria cases would be indicator for coinfection exploration.
The major limitation of our study is the use of SDWF only for TF diagnosis. The cross-reaction of SDWF with many non-pathogen Salmonella, Brucella and Proteus OX-19 have been notified ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1476-0711-10-7", "ISBN" : "1476-0711 (Electronic)\\r1476-0711 (Linking)", "ISSN" : "1476-0711", "PMID" : "21303511", "abstract" : "Serodiagnosis of typhoid fever by Widal test based on demonstrating the presence of agglutinins (antibodies) in the serum of an infected patient, against the H (flagellar) and O (somatic) antigens of Salmonella enterica serotype Typhi has been associated with many debates. This is why the aim of this study was to: (i) Compare the diagnostic accuracy of four different commercial kits used to perform Widal test (Remel, BioSystems, Dialab and Biotec). (ii) Compare the sensitivity and specificity of both anti-O and anti-H antibodies. 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In addition, SDFW cannot discriminated between Salmonella carriage and infection. Thus, TF false positive have been reported using SDWF ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1756-0500-7-653", "ISBN" : "1756-0500", "ISSN" : "1756-0500", "PMID" : "25231649", "abstract" : "BACKGROUND: Typhoid fever is a major health problem in developing countries and its diagnosis on clinical ground is difficult. Diagnosis in developing countries including Ethiopia is mostly done by Widal test. However, the value of the test has been debated. Hence, evaluating the result of this test is necessary for correct interpretation of the result. 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The total number of patients who have indicative of recent infection by either of O and H antigens Widal test is 88 (32.6%). 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Accurate typhoid fever diagnosis need to use hemoculture and/or coproculture. To limit the number of false positive, we have considered only titers of anti-agglutinin O antibodies higher than 1/400 and / or anti-agglutinin H higher than 1/800 positive for Salmonella sp. And also, Andualem et al, have shown a good negative predictive value of SDWF test indicating that negative SDWF results have a good indication for the absence of the disease ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1756-0500-7-653", "ISBN" : "1756-0500", "ISSN" : "1756-0500", "PMID" : "25231649", "abstract" : "BACKGROUND: Typhoid fever is a major health problem in developing countries and its diagnosis on clinical ground is difficult. Diagnosis in developing countries including Ethiopia is mostly done by Widal test. However, the value of the test has been debated. Hence, evaluating the result of this test is necessary for correct interpretation of the result. 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The total number of patients who have indicative of recent infection by either of O and H antigens Widal test is 88 (32.6%). 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Yet, our study has important implication for public health. The high prevalence of "typhomalaria "found in our study raises the question of malaria care management in Burkina Faso. The national malaria management guidelines did not mentioned other infectious diseases exploration in positive malaria cases using microscopy or RDT associated with clinical signs. Malaria concomitant infection with other infectious fever diseases having similar clinical signs could be omitted. It is important to mention in this national guideline to explore other fever diseases mainly TF focused on non-anemia malaria cases almost clinical signs do not improve 48h after an adapted treatment. 
For future research, it would important to determine the potential impact of "typhomalaria" on malaria RDT diagnosis performance in Burkina Faso.

CONCLUSION
Epidemiological profile of typhomalaria in Bobo-Dioulasso indicated that in 1/3 of malaria cases, we have salmonella concomitant infection. Typhomalaria is thus a serious public health problem in Burkina Faso and must be to integrate in the malaria diagnosis algorithm therefore to non-anemia cases.
Interesting research perspective of our study would be to explore epidemiology of other fever diseases associated to malaria and or not in order to elaborate adapted recommendations for fever etiological diagnosis in Burkina Faso.

ACKNOWLEDGEMENTS
Authors thank all the patients who participated in the study and all the staff of the Parasitology and Immunology Lab, Hospital University Souro Sanou of Bobo-Dioulasso and especially Bambara Hafissetou, Gnoumou Nikiemse, Tienou Sogohoun, Zougouri Moustapha, Semd� Abdoulaye and Pooda S�verine for the technical support. 

REFERENCES
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Table legends
Table 1: Biological profile of study participants
Blood parametersCriteriaValuePercent (%)Hemoglobin (g/dL)Minimum1.7Median8.2Mean8.1Maximum17.6Normal6021.2%Anemia22378.8White Blood cell (cell/mm3)Minimum1000Median8000Mean10643Maximum71000normal16357.6%Leukocytosis10336.4%Leukopenia176.0%Eosinophil (cell/mm3)Minimum0Median133Mean215Maximum4499Normal26794.3%Eosinophilia165.7%Neutrophil (cell/mm3)Minimum112Median3606Mean4890Maximum27230Normal18465.0%Neutrophilia279.6%Neutropenia7225.4%


Table 2: Prevalence of typhomalaria and according age, sex and biological parameters
ParametersCriteriaPositiveTotal testedPrevalenceKhi2P valueAge (year)142516.01 to 5246536.04.30.236 to 13143638.9Up to135515735.0SexMale4714033.50,10.8Female5014335.0Hemoglobin
(g/dL)Normal286046.75,20.02Anemia6922330.9WBC (cell/mm3)Normal5416333.1Leukopenia71741.20.50.79Leukocytosis3610334.9Eosinophil ((cell/mm3)Normal9126734.10.010.8Eosinophilia61637.5Neutrophil
(cell/mm3)Normal5416333.1Neutropenia71741.20.50.8)IJKTZ[]����s�_N:$*h�V*h��5�CJH*OJQJaJmH	sH	'h�V*h+<E5�CJOJQJaJmH	sH	!h�,5�CJOJQJaJmH	sH	'h�V*h�`�5�CJOJQJaJmH	sH	'h�V*h�q�5�CJOJQJaJmH	sH	'h�V*h�cH5�CJOJQJaJmH	sH	'h�V*h~%�5�CJOJQJaJmH	sH	'h�V*h�U5�CJOJQJaJmH	sH	'h�V*h";75�CJOJQJaJmH	sH	'h�V*h2'-5�CJOJQJaJmH	sH	'h�V*h��5�CJOJQJaJmH	sH	
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