Prevalence and proportion of Plasmodium spp. triple mixed infections compared with double mixed infections: a systematic review and meta-analysis

• Published in: Malaria Journal
• Main Authors: Manas Kotepui, Kwuntida Uthaisar Kotepui, Giovanni D. Milanez, Frederick R. Masangkay
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2020
• Subjects: Plasmodium; Mixed infection; Triple infection; Quadruple infection; Concurrent infection; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-020-03292-8; https://doaj.org/article/26972bddcec449b9b3e4380176a15000

Abstract Background Although mixed infection by two Plasmodium species has been recognized, mixed infection by three different Plasmodium species within one individual has not been clarified. This study sought to determine the pooled prevalence and proportion of triple mixed Plasmodium spp. infection compared with double mixed infection. Methods Articles from PubMed, Scopus, and Web of Science were searched for cross-sectional studies of triple mixed infection by Plasmodium species and then were retrieved and extracted. The pooled proportion and prevalence of triple mixed infection by Plasmodium species were subjected to random-effects analysis. The secondary outcomes were differences in the pooled proportion between triple mixed infection and double mixed infection by Plasmodium species reported in the included studies. Results Of 5621 identified studies, triple mixed infection data were available for 35 records, including 601 patients from 22 countries. The overall pooled prevalence of triple mixed infection was 4% (95% Confidence Interval (CI) 3–5%; I2 = 92.5%). The pooled proportion of triple mixed infection compared with double mixed infection was 12% (95% CI 9–18; I2 = 91%). Most of the included studies (29/35; 82.9%) presented a lower proportion of triple mixed infection than double mixed infection. Subgroup analysis demonstrated that the proportion of triple mixed infection was the highest in Oceania (23%; 95% CI 15–36%) and Europe (21%; 95% CI 5–86%), but the lowest in the USA (3%; 95% CI 2–4%). Moreover, the proportion of triple mixed infection was higher in residents (20%; 95% CI 14–29%) than in febrile patients (7%; 95% CI 4–13%), when compared with the proportion of double mixed infection. Subgroup analysis of the age groups demonstrated that, compared with the proportion of double mixed infection, triple mixed infection was lower in patients aged ≤ 5 years (OR = 0.27; 95% CI 0.13–0.56; I2 = 31%) and > 5 years (OR = 0.09; 95% CI 0.04–0.25, I2 = 78%). Conclusions The present study suggested that, ...