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Ecol Lett. 2018 Apr;21(4):536-545. doi: 10.1111/ele.12919. Epub 2018 Feb 8.

Competing for blood: the ecology of parasite resource competition in human malaria-helminth co-infections.

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Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.
Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
Department of Medical Microbiology, Erasmus MC, Rotterdam, The Netherlands.


Ecological theory suggests that co-infecting parasite species can interact within hosts directly, via host immunity and/or via resource competition. In mice, competition for red blood cells (RBCs) between malaria and bloodsucking helminths can regulate malaria population dynamics, but the importance of RBC competition in human hosts was unknown. We analysed infection density (i.e. the concentration of parasites in infected hosts), from a 2-year deworming study of over 4000 human subjects. After accounting for resource-use differences among parasites, we find evidence of resource competition, priority effects and a competitive hierarchy within co-infected individuals. For example reducing competition via deworming increased Plasmodium vivax densities 2.8-fold, and this effect is limited to bloodsucking hookworms. Our ecological, resource-based perspective sheds new light into decades of conflicting outcomes of malaria-helminth co-infection studies with significant health and transmission consequences. Beyond blood, investigating within-human resource competition may bring new insights for improving human health.


Ascaris lumbricoides ; Plasmodium falciparum ; Plasmodium vivax ; Hookworms; co-infection interactions; resource competition; within-host ecology

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