Co-infection of sleeping sickness patients with malaria and loiasis in southern Sudan. Maina,

A cross-sectional study was conducted in 2003 on sleeping sickness (SS) patients in the Ibba hospital in Maridi County, western Equatorial province of southern Sudan. The occurrences of co-infection with bloodborne infections and hematological profiles were investigated in SS patients. Fifty SS patients (23 males and 27 females) were included in the study. Most (49) of the patients were in second stage disease, but trypanosomes could be demonstrated in the cerebrospinal fluid (CSF) of only eight of them. Majority of the patients had co-infection with loiasis (36%), malaria (30%) or both loiasis and malaria (10%), and only 24% were free from other infections. Other parasitic infections observed from symptomatic patients were onchocerciasis (2), giardiasis (2), trichomoniasis (2), helminthosis (2) and amoebiasis (2). Co-infection was more common in female (85%) than in male patients (65%), which may be attributed to occupational activities by females. The patients had various disease symptoms including headache (96%), arthralgia/myalgia (88%), pruritus (82%), fever (52%), insomnia (26%) and mental disturbance (20%). The nutritional status of most of them (84%) was below normal Body Mass Index (20-13), and anemia was common (79%). Despite most patients having either normal (66%) or low (12%) white blood cell (WBC) counts, further analysis in 23 of them revealed that majority had lymphocytosis (83%), eosinophilia (96%) and neutropenia (61%), some of which are indicative of a depressed or exhausted immune system. Loa loa parasites obstructed microscopic observation of trypanosomes at the buffy coat interphase of a microhematocrit tube. This study has shown that co-infections of malaria and loiasis are common in SS patients in this region. Apart from the SS and malaria control it would be important to also introduce control programs against nematode infections and particularly loiasis in this region. Combined control of the three diseases would decrease morbidity and co-morbidity due to multiple parasitic diseases.