PARASITIC CO-INFECTIONS: DOES ASCARIS LUMBRICOIDES PROTECT AGAINST PLASMODIUM FALCIPARUM INFECTION?

LAURENT BRUTUS Institut de Recherche pour le Développement, Antananarivo, Madagascar; Institut de la Santé et de la Recherche Médicale Unité 780–IFR 69, Villejuif, France; Institut de Recherche pour le Développement, UR 010, Paris, France; Ministry of Health, Direction de la Lutte contre les Maladies Transmissibles, Antananarivo, Madagascar

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LAURENCE WATIER Institut de Recherche pour le Développement, Antananarivo, Madagascar; Institut de la Santé et de la Recherche Médicale Unité 780–IFR 69, Villejuif, France; Institut de Recherche pour le Développement, UR 010, Paris, France; Ministry of Health, Direction de la Lutte contre les Maladies Transmissibles, Antananarivo, Madagascar

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VALÉRIE BRIAND Institut de Recherche pour le Développement, Antananarivo, Madagascar; Institut de la Santé et de la Recherche Médicale Unité 780–IFR 69, Villejuif, France; Institut de Recherche pour le Développement, UR 010, Paris, France; Ministry of Health, Direction de la Lutte contre les Maladies Transmissibles, Antananarivo, Madagascar

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VIRGINIE HANITRASOAMAMPIONONA Institut de Recherche pour le Développement, Antananarivo, Madagascar; Institut de la Santé et de la Recherche Médicale Unité 780–IFR 69, Villejuif, France; Institut de Recherche pour le Développement, UR 010, Paris, France; Ministry of Health, Direction de la Lutte contre les Maladies Transmissibles, Antananarivo, Madagascar

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HÉLÈNE RAZANATSOARILALA Institut de Recherche pour le Développement, Antananarivo, Madagascar; Institut de la Santé et de la Recherche Médicale Unité 780–IFR 69, Villejuif, France; Institut de Recherche pour le Développement, UR 010, Paris, France; Ministry of Health, Direction de la Lutte contre les Maladies Transmissibles, Antananarivo, Madagascar

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MICHEL COT Institut de Recherche pour le Développement, Antananarivo, Madagascar; Institut de la Santé et de la Recherche Médicale Unité 780–IFR 69, Villejuif, France; Institut de Recherche pour le Développement, UR 010, Paris, France; Ministry of Health, Direction de la Lutte contre les Maladies Transmissibles, Antananarivo, Madagascar

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A controlled randomized trial of antihelminthic treatment was undertaken in 1996–1997 in a rural area of Madagascar where populations were simultaneously infected with Ascaris lumbricoides and Plasmodium falciparum. Levamisole was administered bimonthly to 164 subjects, randomized on a family basis, whereas 186 were controls. While levamisole proved to be highly effective in reducing Ascaris egg loads in the treated group (P < 10−3 at all bimonthly visits), subjects more than 5 years of age, treated with levamisole had a significant increase in their P. falciparum densities compared with controls (P = 0.02), whereas there was no effect of anti-helminthic treatment on children 6 months to 4 years of age. The demonstration of a clear negative interaction between Ascaris infection and malaria parasite density has important implications. Single community therapy programs to deliver treatments against several parasitic infections could avoid an increase of malaria attacks after mass treatment of ascariasis.

Author Notes

Reprint requests: Michel Cot, IRD UR 010, Faculté de Pharmacie, 4 Avenue de l’Observatoire, 75270 Paris Cedex 06, France. E-mail: michel.cot@ird.fr.
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