The significance of parasitic infections in terms of clinical disease: a personal view

Abstract

Throughout the world, infection with parasites is extremely common. Prevalence is highest in the warm countries of the tropics and subtropics, but infection occurs in all climatic zones. The figures usually quoted for the prevalence of specific parasites attain values akin to those used to describe astronomical distances. The World Health Organization (1985) estimated that some 2582 million of the earth's inhabitants live in areas where they risk contracting malaria and that many – in Africa south of the Sahara alone probably 200 million – remain chronically and persistently infected. Estimates for other parasites are similarly impressive; 600 million at risk of infection with schistosomiasis, with some 200 million actually infected; 900 million exposed to lymphatic filarial parasites, with some 90 million currently infected; for onchocerciasis, probably some 40 million cases spread throughout Africa, Central and South America and the Eastern mediterranean. Yet, impressive as these estimates may be, they are dwarfed by those for some intestinal helminths. Recent assessments suggest that 1 person in 4 of the world's population carriesAscaris lumbricoides(Schultz, 1982), while the same proportion is believed to be infected with one or other of the hookworms (Gilman, 1982).