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Although pathogenesis of these infections separately is well studied, there is limited information on the pathogenic disease mechanisms and clinical disease outcomes in co-infections. In this study, we investigated the prevalence of malaria and schistosomiasis co-infections, and the hematologic and blood chemistry abnormalities in asymptomatic adults in a rural fishing community in western Kenya.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This sub-study used samples and data collected at enrollment from a prospective observational cohort study (RV393) conducted in Kisumu County, Kenya. The presence of malaria parasites was determined using microscopy and real-time-PCR, and schistosomiasis infection by urine antigen analysis\u00a0(CCA). Hematological analysis and blood chemistries were performed using standard methods. Statistical analyses were performed to compare demographic and infection data distribution, and hematologic and blood chemistry parameters based on different groups of infection categories. Clinically relevant hematologic conditions were analyzed using general linear and multivariable Poisson regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From February 2017 to May 2018, we enrolled 671 participants. The prevalence of asymptomatic\n                      <jats:italic>Plasmodium falciparum<\/jats:italic>\n                      was 28.2% (157\/556) and schistosomiasis 41.2% (229\/562), with 18.0% (100\/556) of participants co-infected. When we analyzed hematological parameters using Wilcoxon rank sum test to evaluate median (IQR) distribution based on malarial parasites and\/or schistosomiasis infection status, there were significant differences in platelet counts (p\u2009=\u20090.0002), percent neutrophils, monocytes, eosinophils, and basophils (p\u2009&lt;\u20090.0001 each). Amongst clinically relevant hematological abnormalities, eosinophilia was the most prevalent at 20.6% (116\/562), whereas thrombocytopenia was the least prevalent at 4.3% (24\/562). In univariate model, Chi-Square test performed for independence between participant distribution in different malaria parasitemia\/schistosomiasis infection categories within each clinical hematological condition revealed significant differences for thrombocytopenia and eosinophilia (p\u2009=\u20090.006 and p\u2009&lt;\u20090.0001, respectively), which was confirmed in multivariable models. Analysis of the pairwise mean differences of liver enzyme (ALT) and kidney function (Creatinine Clearance) indicated the presence of significant differences in ALT across the infection groups (parasite\u2009+\u2009\/CCA\u2009+\u2009vs all other groups p\u2009&lt;\u2009.003), but no differences in mean Creatinine Clearance across the infection groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study demonstrates the high burden of asymptomatic malaria parasitemia and schistosomiasis infection in this rural population in Western Kenya. Asymptomatic infection with malaria or schistosomiasis was associated with laboratory abnormalities including neutropenia, leukopenia and thrombocytopenia. These abnormalities could be erroneously attributed to other diseases processes during evaluation of diseases processes. Therefore, evaluating for co-infections is key when assessing individuals with laboratory abnormalities. Additionally, asymptomatic infection needs to be considered in control and elimination programs given high prevalence documented here.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-021-06626-2","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T12:04:46Z","timestamp":1631189086000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Epidemiological and clinical implications of asymptomatic malaria and schistosomiasis co-infections in a rural community in western 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The protocol used for this study complied with International Conference on Harmonization Good Clinical Practice guidelines and was conducted in accordance with the principles described in the Nuremberg Code and the Belmont Report including all federal regulations regarding the protection of human participants as described in 32 CFR 219. All participants and impartial witnesses of illiterate participants provided written informed consent before screening and enrollment and had to pass an assessment of understanding.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors report no declarations of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Material has been reviewed by the Walter Reed Army Institute of Research. There is no objection to its presentation and\/or publication. The opinions or assertions contained herein are the private views of the author, and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense. The investigators have adhered to the policies for protection of human subjects as prescribed in AR 70\u201325.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}}],"article-number":"937"}}