Abstract:
Background: In sub-Saharan Africa, Plasmodium falciparum and hepatitis A (HAV) infections are common, especially in
children. Co-infections with these two pathogens may therefore occur, but it is unknown if temporal clustering exists.
Materials and Methods: We studied the pattern of co-infection of P. falciparum malaria and acute HAV in Kenyan children
under the age of 5 years in a cohort of children presenting with uncomplicated P. falciparum malaria. HAV status was
determined during a 3-month follow-up period.
Discussion: Among 222 cases of uncomplicated malaria, 10 patients were anti-HAV IgM positive. The incidence of HAV
infections during P. falciparum malaria was 1.7 (95% CI 0.81–3.1) infections/person-year while the cumulative incidence of
HAV over the 3-month follow-up period was 0.27 (95% CI 0.14–0.50) infections/person-year. Children with or without HAV
co-infections had similar mean P. falciparum asexual parasite densities at presentation (31,000/mL vs. 34,000/mL,
respectively), largely exceeding the pyrogenic threshold of 2,500 parasites/mL in this population and minimizing risk of overdiagnosis
of malaria as an explanation.
Conclusion: The observed temporal association between acute HAV and P. falciparum malaria suggests that co-infections of
these two hepatotrophic human pathogens may result from changes in host susceptibility. Testing this hypothesis will
require larger prospective studies.
