Does Malaria Cause Diarrhoea? A Systematic Review

Isatou Sey, Ajoke M. Ehimiyein, Christian Bottomley, Eleanor M. Riley, Jason P. Mooney

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    Malaria is a systemic febrile disease thatmay progress to prostration, respiratory distress,
    encephalopathy, anemia, and death. Malaria is also an established risk factor for invasive
    bacterial disease caused, in the majority of cases, by invasive enteropathogens and in
    particular by non-Typhoidal Salmonella (NTS). Whilst various malaria-related pathologies
    have been implicated in the risk of NTS bacteraemia in animal models, including
    intestinal dysbiosis and loss of gut homeostasis, clinical evidence is lacking. As a first
    step in gathering such evidence, we conducted a systematic review of clinical and
    epidemiological studies reporting the prevalence of diarrhoea among malaria cases
    and vice versa. Database searches for “plasmodium” and “diarrhoea” identified 1,771
    articles; a search for “plasmodium” and “gastroenteritis” identified a further 215 articles.
    After review, 66 articles specified an association between the search terms and referred
    primarily, but not exclusively, to Plasmodium falciparum infections. Overall, between 1.6
    and 44% of patients with acute malaria infection reported symptoms of diarrhoea (812 of
    7,267 individuals, 11%) whereas 5–42% of patients presenting to hospital with diarrhoea
    had an underlying malaria parasite infection (totaling 749 of 2,937 individuals, 26%).
    However, given the broad range of estimates, a paucity of purposeful case control or
    longitudinal studies, and varied or poorly specified definitions of diarrhoea, the literature
    provides limited evidence to draw any firm conclusions. The relationship between malaria
    and gastrointestinal disturbance thus remains unclear. Carefully designed case-control
    studies and prospective longitudinal studies are required to confidently assess the
    prevalence and significance of intestinal manifestations of malaria parasite infection.
    Original languageEnglish
    Number of pages16
    JournalFrontiers in Microbiology
    Publication statusPublished - 19 Nov 2020


    • malaria
    • plasmodium
    • coinfection
    • diarrhoea
    • intesine
    • systematic review


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