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Shibabaw A, Tilahun M, Gedefie A, Sahle Z, Belete MA, Ebrahim H, Debash H, Sharew B. Magnitude and predisposing factors of intestinal parasitosis and tuberculosis coinfection at five health institutions in Southern Ethiopia: A cross-sectional study. Health Sci Rep 2023; 6:e1569. [PMID: 37736307 PMCID: PMC10509650 DOI: 10.1002/hsr2.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
Background and Aims Intestinal parasites affect the tuberculosis disease outcome by shifting the cell-mediated to humoral immune response and host immune system suppression. However, Mycobacterium tuberculosis (MTB) infection favors the immune escape of parasites. Hence, exploring the rate of intestinal parasitic coinfection with pulmonary tuberculosis (PTB) and its predisposing factors to take better preventive, control, and management measures. Methods A facility-based cross-sectional study was conducted from September to December 2020 at five health institutions in Hawassa city. A total of 214 PTB patients were diagnosed using the GeneXpert assay and enrolled in this study. Demographic, clinical, and risk factors data were collected using a structured questionnaire. Stool samples were collected using a clean, labeled, and leak-proof stool cup. Stool samples were examined using direct saline microscopy and the formal-ether concentration technique. The data were entered and coded in SPSS software for analysis. Bivariate and multivariate logistic regression were employed to identify the associated risk factors. A p-value less than 0.05 was considered statistically significant. Results The overall rate of intestinal parasitic-MTB coinfection was 36.9%. The most dominant intestinal parasite was Gardia lamblia (17.8%, 38), followed by Entamoeba histolytica/dispar (9.3%, 20). Intestinal parasitosis coinfection of PTB was associated with being rural resident (adjusted odds ratio [AOR] = 2.42; 95% confidence interval [CI]: 1.23-4.8), not washing of fruits and vegetables before eating [AOR = 4.14; 95% CI: 1.92-9], being at the early stage of anti-TB treatment [AOR = 3; 95% CI: 1.5-6.3] and presence of chronic diseases [AOR = 7; 95% CI: 3.4-14]. Conclusion The burden of intestinal parasites-MTB coinfection was high. Those who wash fruits and vegetables before eating should be encouraged, early treatment of PTB patients and avoiding the practice of open-field defecation, especially in rural communities, is necessary. The dual effect of coinfection on disease severity and treatment success needs further cohort study.
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Affiliation(s)
- Agumas Shibabaw
- Department of Medical Laboratory Sciences, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Zenawork Sahle
- Department of Medical Laboratory SciencesDebre Birhan Health Science CollegeDebre BirhanEthiopia
| | - Melaku A. Belete
- Department of Medical Laboratory Sciences, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Hussen Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Habtu Debash
- Department of Medical Laboratory Sciences, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
| | - Bekele Sharew
- Department of Medical Laboratory Sciences, College of Medicine and Health SciencesWollo UniversityDessieEthiopia
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Dessie G, Negesse A, Wagnew F, Amare D, Tiruneh BZ, Mulugeta H, Mekonen BA, Haile D, Ayalew T, Habtewold TD. Intestinal parasites and HIV in Ethiopian tuberclosis patients: A systematic review and meta-analysis. CURRENT THERAPEUTIC RESEARCH 2020; 93:100603. [PMID: 32963640 PMCID: PMC7490528 DOI: 10.1016/j.curtheres.2020.100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The distribution of intestinal parasites among patients with tuberculosis in Ethiopia is not well understood. OBJECTIVE This systematic review and meta-analysis was designed to determine the pooled national prevalence of intestinal parasites and its association with HIV among patients with tuberculosis in Ethiopia. METHODS Original articles were searched in PubMed, Google Scholar, EMBASE, World Health Organization's HINARI portal, and supplemented by the hand searching of cross-references. Data were extracted using a standard data extraction checklist. Random-effects model was used to estimate the pooled prevalence of intestinal parasites and odds ratio of the association. The I 2 statistic was utilized to quantify statistical heterogeneity across studies. Funnel plot asymmetry and Egger regression tests were used to check for publication bias. The analysis was done by STATA version 14 for Windows. RESULTS Of 725 identified studies, 12 articles were eligible for inclusion in the final analysis. The pooled national prevalence of intestinal parasites among patients with tuberculosis in Ethiopia was 36.1% (95% CI, 22.1-50.1; I 2 = 98.7%). Subgroup analysis based on study design indicated that the prevalence of intestinal parasite among case-control studies was 41.69% (95% CI, 28.6-54.8; I 2 = 95.1%). The odds of intestinal parasites among patients with tuberculosis-HIV coinfection was not significantly different compared with patients with tuberculosis without HIV/AIDS (odds ratio = 0.99; 95% CI, 0.7-4.7; P = 0.96). CONCLUSIONS In Ethiopia, at least 1 out of 3 patients with tuberculosis have an intestinal parasite. These findings suggest a need of more attention on increasing screening tuberculosis patients for intestinal parasites and deworming interventions. (Curr Ther Res Clin Exp. 2020; 81:XXX-XXX).
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Affiliation(s)
- Getenet Dessie
- Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahr Dar University, Bahir Dar, Ethiopia
| | - Ayenew Negesse
- Department of Human Nutrition and Food Science, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Fasil Wagnew
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Desalegne Amare
- Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahr Dar University, Bahir Dar, Ethiopia
| | - Balew Zeleke Tiruneh
- Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahr Dar University, Bahir Dar, Ethiopia
| | - Henok Mulugeta
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Berhanu Abebaw Mekonen
- Department of Nutrition, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahr Dar, Ethiopia
| | - Dessalegn Haile
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tilksew Ayalew
- Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahr Dar University, Bahir Dar, Ethiopia
| | - Tesfa Dejenie Habtewold
- Department of Quantitative Economics, School of Business and Economics, Maastricht University, Maastricht
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Alemu A, Bitew ZW, Worku T. Intestinal parasites co-infection among tuberculosis patients in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2020; 20:510. [PMID: 32664873 PMCID: PMC7362415 DOI: 10.1186/s12879-020-05237-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/07/2020] [Indexed: 01/04/2023] Open
Abstract
Background Tuberculosis and intestinal parasites are mostly affecting poor people. They are in a vicious since one is the risk factor for the other. However, the comprehensive report on the burden and co-incidence of intestinal parasites and tuberculosis in Ethiopia is scant. This systematic review and meta-analysis aimed to provide abridge conclusive evidence on the intestinal parasite-tuberculosis co-infection in Ethiopia. Methods A total of 414 articles published in English were searched from both electronic databases (CINAHL, DOAJ, Embase, Emcare, Medline, ProQuest, and PubMed, Science Direct, and Web of Science) and other sources. The qualities of the included studies were assessed using the Joanna Briggs Institute Critical Appraisal tools and the publication bias was measured using the funnel plot and Eggers regression test. Comprehensive meta-analysis (CMA) Version 3.3.07 and Review Manager software were used to estimate pooled prevalence and associations of intestinal parasites and tuberculosis infection. Results Eleven articles with a total of 3158 tuberculosis patients included in the analysis based on the eligibility criteria. The estimated pooled prevalence of intestinal parasites co-infection was 33% (95% CI: 23.3, 44.3) using the random-effects model. The most common intestinal parasites were Ascaris lumbricoides 10.5% (95% CI: 6.0, 17.5), Hookworm 9.5% (95% CI: 6.10, 14.4), Giardia lamblia 5.7% (95% CI: 2.90, 10.9) and Strongyloides sterocoralis 5.6% (95% CI: 3.3, 9.5). The odds of intestinal parasites infection was higher among tuberculosis patients compared to tuberculosis free individuals (OR = 1.76; 95% CI: 1.17, 2.63). A significant difference was observed among TB patients for infection with intestinal helminths (OR = 2.01; 95% CI: 1.07, 3.80) but not for intestinal protozoans when compared with their counterparts. The odds of multiple parasitic infections was higher among tuberculosis patients (OR = 2.59, 95% CI: 1.90, 3.55) compared to tuberculosis free individuals. However, intestinal parasites co-infection was not associated with HIV status among tuberculosis patients (OR = 0.97; 95% CI: 0.71, 1.32). Conclusion One-third of tuberculosis patients are co-infected with one or more intestinal parasites, and they are more likely to be infected with intestinal helminths and multiple intestinal parasitic infections compared to TB free individuals. We recommend routine screening of tuberculosis patients for intestinal parasites. The effect of mass deworming on tuberculosis incidence would be important to be considered in future researches. Trial registration Registered on PROSPERO with reference number ID: CRD42019135350.
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Affiliation(s)
- Ayinalem Alemu
- Ethipian Public Health Institute, Addis Ababa, Ethiopia.
| | - Zebenay Workneh Bitew
- Department of Pediatric Nursing, School of Nursing, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Teshager Worku
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Taghipour A, Mosadegh M, Kheirollahzadeh F, Olfatifar M, Safari H, Nasiri MJ, Fathi A, Badri M, Piri Dogaheh H, Azimi T. Are intestinal helminths playing a positive role in tuberculosis risk? A systematic review and meta-analysis. PLoS One 2019; 14:e0223722. [PMID: 31613921 PMCID: PMC6793940 DOI: 10.1371/journal.pone.0223722] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/26/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Co-infection of intestinal helminthic infections (IHIs) and tuberculosis (TB) has appeared as a public health issue, especially in developing countries. Some recent studies have been carried out on the possible relevance of IHIs to TB. The current systematic review and meta-analysis was conducted to assess the prevalence and odds ratio (OR) of IHIs among TB patients and clarify the relationship between IHIs and TB disease. METHODS For the purpose of the study, five English databases including PubMed, Science Direct, Scopus, Web of Science (ISI), and Google scholar were searched (up to January 30, 2019) in order to find the related studies. Random-effects meta-analysis model was used to estimate the pooled prevalence, odds ratio (OR), and 95% confidence interval (CI). Inclusion and exclusion criteria were applied. RESULTS A total of 20 studies including 10 studies with case-control design (2217 patients and 2520 controls) and 10 studies with cross-sectional design (a total of 2415 participants) met the eligibility criteria. As shown by the random-effects model, the pooled prevalence of IHIs in TB patients was estimated to be 26% (95% CI, 17-35%; 1249/4632). The risk of IHI was higher in TB patients compared to controls but this was not statistically significant. However, according to genus/species, the pooled OR of Strongyloides stercoralis (S. stercoralis) (OR, 2.68; 95% CI, 1.59-4.54) had a significantly higher risk in TB patients compared to controls. Nevertheless, the results of random effects model showed no statistically significant association between overall pooled OR of IHIs in TB patients compared to controls in case-control studies (OR, 1; 95% CI, 0-1). CONCLUSIONS It is highly recommended that more precise studies should be carried out by researchers in order to better understand this association. Also, it is of great importance to include the periodic screenings for IHIs in the routine clinical care of these patients.
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Affiliation(s)
- Ali Taghipour
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mehrdad Mosadegh
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kheirollahzadeh
- Biology Department, School of Basic Science, Science and Research Branch Islamic Azad University (SRBIAU), Poonak, Tehran, Iran
| | - Meysam Olfatifar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Safari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Fathi
- Faculty of veterinary medicine, University of Zabol, Zabol, Iran
| | - Milad Badri
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hadi Piri Dogaheh
- Department of Microbiology, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran
| | - Taher Azimi
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Alemu A, Kebede A, Dagne B, Amare M, Diriba G, Yenew B, Tesfaye E, Tadesse M, Sinshaw W, Challa D, Desta K. Intestinal parasites co-infection and associated factors among active pulmonary tuberculosis patients in selected health centers, Addis Ababa, Ethiopia: unmatched case control study. BMC Infect Dis 2019; 19:407. [PMID: 31077142 PMCID: PMC6511174 DOI: 10.1186/s12879-019-4009-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/22/2019] [Indexed: 01/01/2023] Open
Abstract
Background In co-endemic areas, rate of intestinal parasites and tuberculosis (TB) co-infection thought to be high. However, there are limited studies on the epidemiology of this co-infection in Ethiopia. Therefore, the present study aimed to generate evidence on intestinal parasites co-infection rate and associated factors among pulmonary tuberculosis patients (PTB) and their household contacts in Addis Ababa, Ethiopia. Methods Unmatched case-control study was conducted. Data were collected from 91 PTB patients (cases) and 89 household contacts (controls). Socio-demographic characteristics and associated factors were collected using structured questionnaire. Sputum, stool and blood specimens were collected, processed and examined for PTB, intestinal parasites and Human Immunodeficiency virus anti-body test, respectively. Data were entered and analyzed by Statistical Packages for Social Sciences (SPSS) Version 20. Descriptive statistics, Fisher’s exact test, binary logistic regression, and odds ratio were used. P-value of < 0.05 was considered as statistically significant. Results The infection rate of intestinal parasites based on one stool samples in PTB patients and controls was 22 and 9%, respectively. The difference was statistically significant (COR = 2.85;95% CI = 1.18–6.87). The most prevalent intestinal parasite in PTB patients was Gardia lamblia (8.8%, 8), followed equally by Ascaris lumbricoides, Haymenolopsis nana and Entamoeba histolytica/dispar (4.4%, 4). Co-infection in PTB patients was associated with body mass index (BMI) < 18.5 (AOR = 6.71;95% CI = 1.65–27.25) and dirty material in finger nails (AOR = 8.99;95% CI = 2.46–32.78). There was no variable associated with parasitic infections in controls in our analysis, which might be due to the low prevalence of intestinal parasites’. Conclusions There was a statistical significant difference in the infection rate of intestinal parasites in PTB patients compared to healthy household contacts. The consequence of co-infection on developing an active disease, disease severity and treatment efficacy needs to be investigated in future.
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Affiliation(s)
- Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia. .,Department of Medical Laboratory Science, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Abebaw Kebede
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Biniyam Dagne
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Misikir Amare
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bazezew Yenew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ephrem Tesfaye
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Dawit Challa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kassu Desta
- Department of Medical Laboratory Science, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Kwizera R, Parkes-Ratanshi R, Page ID, Sekaggya-Wiltshire C, Musaazi J, Fehr J, Castelnuovo B, Kambugu A, Denning DW. Elevated Aspergillus-specific antibody levels among HIV infected Ugandans with pulmonary tuberculosis. BMC Pulm Med 2017; 17:149. [PMID: 29162063 PMCID: PMC5699185 DOI: 10.1186/s12890-017-0500-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of tuberculosis (TB) is high among human immunodeficiency virus (HIV) infected Ugandans. Recent evidence suggests that Chronic Pulmonary Aspergillosis and Aspergillus sensitisation might be responsible for significant mortality in patients treated for tuberculosis in Uganda. METHODS We retrieved and tested paired serum aliquots for 101 HIV-TB co-infected patients at the beginning and week 24 of TB treatment. We tested samples for Aspergillus-specific immunoglobulin G (IgG) and immunoglobulin E (IgE) using ImmunoCAP®; and Aspergillus-specific IgG and total serum IgE using Immulite® immunoassays. We compared antibody levels between baseline and week 24, relating them to selected baseline characteristics. RESULTS 10% of the patients had elevated Aspergillus-specific IgE (Aspergillus sensitization) and Aspergillus-specific IgG antibodies were elevated in 9% of the patients at the end of TB treatment. There was a significant fall in the Aspergillus-specific IgG antibody levels between baseline and week 24 (P = 0.02). Patients with cluster of differentiation 4 (CD4) T-cell count <100 cells/μl and those who were not on anti-retroviral therapy at baseline had more elevated Aspergillus-specific IgG antibodies (P = 0.01, P = 0.03). The ImmunoCAP® Aspergillus-specific IgG antibody titres were higher at week 24 than baseline with more positives at week 24; even though the difference in means was small. However, this difference was statistically significant (P = 0.02). Pulmonary infiltrates were the commonest x-ray abnormality and only 5% of the patients had pulmonary cavities on chest x-ray at week 24. CONCLUSION These results suggest that Aspergillus infection may complicate active pulmonary TB and further studies including fungal culture and thoracic imaging may now be indicated to measure the prevalence of pulmonary aspergillosis complicating tuberculosis. TRIAL REGISTRATION The SOUTH trial was registered prospectively. ClinicalTrials.gov Identifier: NCT01782950 ; Registration date: 4th February 2013; Last verified: 13th April 2015.
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Affiliation(s)
- Richard Kwizera
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O.BOX 22418, Kampala, Uganda.
| | - Rosalind Parkes-Ratanshi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O.BOX 22418, Kampala, Uganda.,Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Iain D Page
- The University of Manchester, Manchester, UK.,National Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK
| | | | - Joseph Musaazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O.BOX 22418, Kampala, Uganda
| | - Jan Fehr
- Infectious Diseases and Hospital Hygiene, University Hospital, Zurich, Switzerland
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O.BOX 22418, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O.BOX 22418, Kampala, Uganda
| | - David W Denning
- The University of Manchester, Manchester, UK.,National Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK
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Mulu A, Anagaw B, Gelaw A, Ota F, Kassu A, Yifru S. Effect of deworming on Th2 immune response during HIV-helminths co-infection. J Transl Med 2015; 13:236. [PMID: 26187732 PMCID: PMC4506626 DOI: 10.1186/s12967-015-0600-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 07/08/2015] [Indexed: 11/29/2022] Open
Abstract
Background Helminths infections have been suggested to worsen the outcome of HIV infection by polarizing the immune response towards Th2. The purpose of this study is to determine the activity of Th2 immune response by measuring total serum IgE level during symptomatic and asymptomatic HIV infection with and without helminths co-infection and to define the role of deworming and/or ART on kinetics of serum IgE. Methods This prospective comparative study was conducted among symptomatic HIV-1 infected adults, treatment naïve asymptomatic HIV positive individuals and HIV negative apparently healthy controls with and without helminths co-infection. Detection and quantification of helminths and determination of serum IgE level, CD4+, and CD8+ T cell count were done at baseline and 12 weeks after ART and/or deworming. Results HIV patients co-infected with helminths showed a high level of serum IgE compared to HIV patients without helminths co-infection (1,688 [IQR 721–2,473] versus 1,221 [IQR 618–2,289] IU/ml; P = 0.022). This difference was also markedly observed between symptomatic HIV infected patients after with and without helminths infection (1,690 [IQR 1,116–2,491] versus 1,252 [703–2,251] IU/ml; P = 0.047). A significant decline in serum IgE level was observed 12 weeks after deworming and ART of symptomatic HIV infected patients with (1,487 versus 992, P = 0.002) and without (1,233 versus 976 IU/ml, P = 0.093) helminths co-infection. However, there was no significant decrease in serum IgE level among asymptomatic HIV infected individuals (1,183 versus 1,097 IU/ml, P = 0.13) and apparently health controls (666 IU/ml versus 571, P = 0.09) without helminths co-infection 12 weeks after deworming. Conclusions The significant decline of serum IgE level 12 weeks after deworming of both symptomatic and asymptomatic patients indicate a tendency to down-regulate the Th2 immune response and is additional supportive evidence that deworming positively impacts HIV/AIDS diseases progression. Thus, deworming should be integrated with ART program in helminths endemic areas of tropical countries.
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Affiliation(s)
- Andargachew Mulu
- Department of Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. .,Institute of Virology, Leipzig University, Johannisallee 30, 04103, Leipzig, Germany.
| | - Belay Anagaw
- Department of Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Aschalew Gelaw
- Department of Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Fuso Ota
- Department of Preventive Environment and Nutrition, Graduate School of Nutrition and Bioscience, Institute of Health Biosciences, The University of Tokushima, Tokushima, 770-8503, Japan.
| | - Afework Kassu
- Department of Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Sisay Yifru
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Hailu AW, G/Selassie S, Merid Y, Gebru AA, Ayene YY, Asefa MK. The case control studies of HIV and Intestinal parasitic infections rate in active pulmonary tuberculosis patients in Woldia General Hospital and Health Center in North Wollo, Amhara Region, Ethiopia. INTERNATIONAL JOURNAL OF PHARMA SCIENCES 2015; 5:1092-1099. [PMID: 26998497 PMCID: PMC4795907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Tuberculosis remains a major health problem worldwide in the era of HIV/AIDS. Co-infection with intestinal parasites has been suggested to worsen the outcome of infection in addition to HIV infection. Hence, adequate information on TB patients with HIV and intestinal parasites infection is being needed to tackle the problem, undertake the integrated prevention and control program. This study was aimed to assess the prevalence of HIV and intestinal parasitic infections in active pulmonary tuberculosis patients compared with their healthy extended family of the subject as a control. A case-control study was carried out from November, 2010 to June, 2011 in Woldia General Hospital and Woldia Health Center. Stool sample were examined using direct technique and formol-ether concentration techniques. Modified acid fast stain was used to identify Oocysts of Cryptosporidium species and Isospora belli. HIV rapid tests were used to screen sero prevalence and AFB smear microscopy for screening Pulmonary TB patients. A total of 100 smear positive TB patients and 168 familial contacts were participated and the overall prevalence of intestinal parasite among TB patients was 49%; compared to 23.2% of the control. 41% of TB patients and 23.8% controls were found to be HIV infected. Double infection with both intestinal parasite and HIV was found in 61% TB patients and 52.5% of the controls. The proportions of TB patients infected with 1, 2, or more species of worms were 73.5%, 26.5% respectively; 82%, 18% were in controls and the odds of being an active TB patient is increased with the number of species of intestinal parasites the person harbors. The current study showed that a significant association between TB/HIV infection and intestinal parasite particularly Strongyloides stercoralis Cryptosporidium parvum and Isospora belli.
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Affiliation(s)
| | - Solomon G/Selassie
- Addis Ababa University, School of Medicine, Department of Microbiology, Immunology and Parasitology
| | - Yared Merid
- Hawassa University, College of Medicine, Medical Microbiology Unit, Hawassa University, Department of Microbiology, Hawassa, Ethiopia
| | - Addis Adera Gebru
- Woldia University, Faculty of Health Sciences, Department of Nursing, P.O.Box 400, Woldia, North Wollo, Amhara Region, Ethiopia
| | - Yonas Yimam Ayene
- Woldia University, Faculty of Health Science, Department of Nursing, P.O.Box -400, Woldia, North Wollo, Amhara Region, Woldia, Ethiopia
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Mulu A, Kassu A, Legesse M, Erko B, Nigussie D, Shimelis T, Belyhun Y, Moges B, Ota F, Elias D. Helminths and malaria co-infections are associated with elevated serum IgE. Parasit Vectors 2014; 7:240. [PMID: 24886689 PMCID: PMC4063426 DOI: 10.1186/1756-3305-7-240] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/19/2014] [Indexed: 02/05/2023] Open
Abstract
Background Both helminth and malaria infections result in a highly polarized immune response characterized by IgE production. This study aimed to investigate the total serum IgE profile in vivo as a measure of Th2 immune response in malaria patients with and without helminth co-infection. Methods A cross sectional observational study composed of microscopically confirmed malaria positive (N = 197) and malaria negative (N = 216) apparently healthy controls with and without helminth infection was conducted at Wondo Genet Health Center, Southern Ethiopia. A pre-designed structured format was utilized to collect socio-demographic and clinical data of the subjects. Detection and quantification of helminths, malaria parasites and determination of serum IgE levels were carried out following standard procedures. Results Irrespective of helminth infection, individuals infected by malaria showed significantly high levels of serum IgE compared with malaria free apparently healthy controls (with and without helminth infections). Moreover, malaria patients co-infected with intestinal helminths showed high level of serum IgE compared with those malaria patients without intestinal helminths (2198 IU/ml versus 1668 IU/ml). A strong statistically significant association was observed between malaria parasite density and elevated serum IgE levels (2047 IU/ml versus 1778 IU/ml; P = 0.001) with high and low parasitaemia (parasite density >50,000 parasite/μl of blood), respectively. Likewise, helminth egg loads were significantly associated with elevated serum IgE levels (P = 0.003). Conclusions The elevated serum IgE response in malaria patients irrespective of helminth infection and its correlation with malaria parasite density and helminth egg intensity support that malaria infection is also a strong driver of IgE production as compared to helminths.
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Affiliation(s)
- Andargachew Mulu
- Department of Microbiology, College of Medicine, University of Gondar, Gondar, Ethiopia.
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Araujo Z, Giampietro F, Rivas-Santiago B, Luna-Herrera J, Wide A, Clark W, de Waard JH. Patients exposed to Mycobacterium tuberculosis infection with a prominent IgE response. Arch Med Res 2012; 43:225-32. [PMID: 22564424 DOI: 10.1016/j.arcmed.2012.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 03/30/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Even though it has been reported that chronic immune activation associated with intestinal helminthic infections results in a predominant IgE response, specific IgE antibodies that are also interleukin 4 (IL-4) dependent have been reported in tuberculosis patients; however, this fact has not been widely reported. This study was aimed at investigating the levels of circulating IgE in Warao (an indigenous population) of the Orinoco river delta, an area isolated from contact with the tubercle bacillus for millennia until the mid-1960s as compared to Creole (nonindigenous population). METHODS A total of 294 individuals were studied, 161 Warao and 136 Creole. Patient group was comprised of 86 Warao patients (WP) and 60 Creole patients (CP). Control group was comprised of 75 Warao controls (WC) and 76 Creole controls (CC). Total serum IgE and IgE and IgG(4) reactivities to M. tuberculosis antigens were measured by an enzyme-linked immunosorbent assay (ELISA). RESULTS Levels of total serum IgE were significantly elevated in WP (13002.0 ± 11200.0 IU/mL) and WC (2763.5 ± 2596.2 IU/mL) than in CP (385.9 ± 155.1 IU/mL) and CC (356.6 ± 157.5 IU/mL) (p <0.0001). Anti-PPD and anti-H37Rv IgE were significantly higher in WP (0.240 ± 0.145 and 0.230 ± 0.155) than in CP (0.127 ± 0.152 and 0.97 ± 0.103, respectively) and also between WC (0.240 ± 0.273 and 0.147 ± 0.158) and CC (0.115 ± 0.136 and 0.43 ± 0.46, respectively) (p <0.0001). Anti-PPD and anti-H37Rv IgG(4) did not show differences among groups; however, anti-H37Rv IgG(4) was affected by anti-TB treatment, which could be predictive of treatment outcome. CONCLUSIONS The findings suggest that for the Warao population there is an intrinsic propensity to produce a high IgE response, which could be incompatible with the protective response to M. tuberculosis.
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Affiliation(s)
- Zaida Araujo
- Laboratorio de InmunologÍa de Enfermedades Infecciosas, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela.
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Kassu A, Fujino M, Matsuda M, Nishizawa M, Ota F, Sugiura W. Molecular epidemiology of HIV type 1 in treatment-naive patients in north Ethiopia. AIDS Res Hum Retroviruses 2007; 23:564-8. [PMID: 17451346 DOI: 10.1089/aid.2006.0270] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To understand the predominant HIV subtype and drug-resistant viruses in northwest Ethiopia, isolates from 92 antiretroviral drug-naive HIV-1-infected tuberculosis patients were analyzed. Of these patients, 90 (97.8%) were found to be infected with viral subtype C. Other isolates had subtype A (1.1%) and subtype D (1.1%). No primary mutations were associated with protease inhibitor drug resistance. One case (1.1%) had the reverse-transcriptase mutation, V75I. Two patients (2.2%) had the G190A mutation, which confers resistance to the nonnucleoside reverse transcriptase inhibitor, nevirapine. Our study demonstrates that subtype C is the major HIV-1 subtype in northwest Ethiopia. Our results also reveal that the population in the study area had been exposed to antiretrovirals and that treatment-naive patients had drug resistance mutations. Thus, our results emphasize the need for routine drug resistance monitoring in northwest Ethiopia.
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Affiliation(s)
- Afework Kassu
- Department of Preventive Environment and Nutrition, Institute of Health Biosciences, University of Tokushima, Tokushima 770-8503, Japan
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Kassu A, Yabutani T, Mahmud ZH, Mohammad A, Nguyen N, Huong BTM, Hailemariam G, Diro E, Ayele B, Wondmikun Y, Motonaka J, Ota F. Alterations in serum levels of trace elements in tuberculosis and HIV infections. Eur J Clin Nutr 2006; 60:580-6. [PMID: 16340948 DOI: 10.1038/sj.ejcn.1602352] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate serum concentrations of trace elements in tuberculosis (TB) patients with or with out human immunodeficiency virus (HIV) coinfection before and after anti-TB chemotherapy. SUBJECTS A total of 155 TB patients, 74 of which were coinfected with HIV, and 31 healthy controls from Gondar, Ethiopia. METHODS Serum levels of copper, zinc, selenium and iron were determined using an inductively coupled plasma mass spectrometer from all subjects at baseline and from 44 TB patients (22 with HIV coinfection) at the end of an intensive phase of anti-TB chemotherapy. RESULTS Compared with the control group, the concentrations of iron, zinc and selenium were significantly lower (P<0.05) while that of copper and copper/zinc ratio was significantly higher (P<0.05) in the serum of TB patients. TB patients with HIV coinfection had significantly lower serum zinc and selenium concentrations and significantly higher copper/zinc ratio compared to that in TB patients without HIV coinfection (P<0.05). The serum concentration of zinc had significantly increased at the end of intensive phase of anti-TB chemotherapy in patients without HIV coinfection (P<0.05). An increase in serum selenium level was observed in TB patients with or without HIV coinfection after therapy. On the contrary, serum copper concentration and copper/zinc ratio declined significantly after anti-TB chemotherapy irrespective of HIV serostatus (P<0.05). CONCLUSIONS The results indicate that TB patients have altered profile of trace elements in their sera. This warrants the need for further investigations so that strategies for trace elements supplementation can be planned in addition to their potential as diagnostic parameters in monitoring responses to anti-TB chemotherapy.
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Affiliation(s)
- A Kassu
- Department of Preventive Environment and Nutrition, Systems of Nutritional Sciences, Graduate School of Health Biosciences Research, The University of Tokushima, Tokushima, Japan
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Moges F, Kassu A, Mengistu G, Adugna S, Andualem B, Nishikawa T, Ota F. Seroprevalence of Helicobacter pylori in dyspeptic patients and its relationship with HIV infection, ABO blood groups and life style in a university hospital, Northwest Ethiopia. World J Gastroenterol 2006; 12:1957-61. [PMID: 16610007 PMCID: PMC4087526 DOI: 10.3748/wjg.v12.i12.1957] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 06/22/2005] [Accepted: 06/22/2005] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the prevalence of Helicobacter pylori (H pylori) among dyspeptic patients and to assess the relationship between H pylori infection, blood group, HIV infection and life style of the patients. METHODS In a hospital-based cross-sectional study, patients attending Outpatient Department of University of Gondar Hospital were enrolled. Socio-demographic information was collected using questionnaires. Serum was analyzed for anti-H pylori IgG antibodies using a commercial kit. HIV serostatus was determined by enzyme-linked immunosorbent assay (ELISA). Blood grouping was performed by slide agglutination tests. RESULTS A total of 215 dyspeptic patients were included in the study. One hundred and sixteen patients (54%) were females and 99 (46%) were males. Anti-H pylori IgG antibodies were detected in sera of 184 (85.6%) patients. The prevalence was significantly higher in patients aged 50 years and above. Twenty point five percent of the patients were found to be seropositive for HIV. No significant association was found between sex, ABO blood groups, consumption of spicy diets, socio-economic status and seropositivity for H pylori. However, alcohol consumption was significantly associated with H pylori serology. CONCLUSION The prevalence of H pylori infection is associated with a history of alcohol intake and older age. The effect of different diet, alcohol and socioeconomic status as risk factors for H pylori infection needs further study.
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Affiliation(s)
- Feleke Moges
- Department of Microbiology and Parasitology, Gondar College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, Ethiopia.
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