Prevalence of malaria and scrub typhus co-infection in febrile patients: a systematic review and meta-analysis

Abstract

Background Little information is available about malaria and scrub typhus co-infection. This study aimed to investigate the pooled prevalence of malaria and scrub typhus co-infection in febrile patients. Further, it aimed to estimate the prevalence of scrub typhus infection among patients with malaria and the odds of co-infection. This will aid the diagnosis and management of co-infected patients in endemic areas. Methods We searched for relevant studies in three databases: PubMed, Scopus, and Web of Science. We assessed the quality of the included studies using the Joanna Briggs Institute checklist for analytical cross-sectional studies. We estimated (1) the pooled prevalence of malaria and scrub typhus co-infection, (2) the pooled prevalence of scrub typhus infection in malaria-positive patients, and (3) the pooled odds of co-infection using the DerSimonian–Laird method for random-effects models. The study results and summary estimates were visualized on a forest plot as point estimates (effect size, prevalence) and 95% confidence intervals (CI). We assessed the heterogeneity of the studies by Cochrane Q or I2 statistics. We performed subgroup analyses of countries and scrub typhus diagnostic tests to explore the sources of heterogeneity of the included studies. We assessed publication bias if more than 10 studies were used to estimate the outcome. All data analyses were conducted using Stata version 14 (StataCorp, College Station, TX, USA). Results Of the 542 studies retrieved from three databases, we included 14 meeting the inclusion criteria in the systematic review and meta-analysis. The pooled prevalence of malaria and scrub typhus co-infection (56 cases) among febrile patients (7920 cases) was 1% (95% CI: 0–1%, I2: 78.28%), while the pooled prevalence of scrub typhus infection (321 cases) in patients with malaria (1418 cases) was 21% (95% CI: 12–30%, I2: 98.15%). Subgroup analysis showed that the pooled prevalence of scrub typhus infection among patients with malaria in India was 8% (95% CI: 4–13%, I2: 85.87%, nine studies with 59/794 cases), while the pooled prevalence of scrub typhus infection among patients with malaria in Thailand was 35% (95% CI: 7–64%, I2: 98.9%, four studies with 262/624 cases). The co-infections did not occur by chance (P = 0.013, odds: 0.43, 95% CI: 0.22–0.84%, I2: 60.9%). In the sensitivity analysis, the pooled prevalence of malaria and scrub typhus co-infection among febrile patients was 0% (95% CI: 0–1%, I2: 59.91%). Conclusions The present study showed the pooled prevalence and a significant association between malaria and scrub typhus. The results show the status of co-infection. Further research into co-infection in endemic areas is needed, in particular, to determine whether co-infection can accelerate disease progression or protect against severe disease. Graphical abstract

Malaria prevalence in Pakistan: A systematic review and meta-analysis (2006–2021)

“…A meta-analysis was conducted in 2021, which showed the spread of Malaria in India and Thailand was 8% (95% CI: 4–13%, I 2 : 85.87%, nine studies with 59/794 cases) and 35% (95% CI: 7–64%, I 2: 98.9%, four studies with 262/624 cases) [ 70 ]. And so meta-analysis was done also in Afghanistan, Iran, and China, which showed the spread of Malaria which was 0.15 (95%CI: 0.10–0.21; I2 = 83.3%) [ 71 ], 63% (95% CI 51–74%; seven studies) [ 72 ] and 9% (2006/35,768, 95% CI 7.0–12.0%) [ 73 ].…”

Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives

“…It has been previously reported that 15% of scrub typhus cases had coinfection with other diseases [53]. Identifying coinfections is an important challenge for clinicians, as some are treatable diseases such as influenza, malaria, leptospirosis, typhoid or melioidosis [54][55][56][57][58][59][60][61][62][63]. Others have described severe manifestation in scrub typhus co-infected with dengue and other viral infections [64][65][66][67][68].…”

Scrub Typhus: Epidemiology, Clinical Presentations, and Diagnostic Approaches

“…A study conducted in various Indian states including Assam, Meghalaya, and Arunachal Pradesh revealed the occurrence of scrub typhus co-infections along with other febrile illnesses such as leptospirosis, dengue, chikungunya, bacteraemia, pulmonary tuberculosis, and malaria [31,35,52,68,82]. High prevalence of co-infections of about 35% between scrub typhus and malaria was observed in Thailand and low prevalence in India exclusively, according to the recent review report [83].…”