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Mekuria M, Abebe G, Hasen H, Zeynudin A. Bacilli load in PTB- intestinal helminths co-infected and PTB non -infected patients at selected public health facilities in Jimma zone, Oromia, Ethiopia: comparative cross-sectional study. BMC Infect Dis 2024; 24:783. [PMID: 39103799 DOI: 10.1186/s12879-024-09673-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/26/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) and intestinal helminths are diseases that pose a dual burden on public health in low-income countries. Previous studies have shown that helminths can affect the shedding of bacteria or the bacterial load in the sputum of active TB patients. However, there is limited information on bacterial load in TB patients with helminth infections. OBJECTIVE This study aimed to compare bacterial load in helminths-infected and non-infected pulmonary tuberculosis patients at selected public health facilities in Jimma zone, Oromia, Ethiopia. METHODS The study was conducted in Jimma Zone, Oromia, Ethiopia. A facility-based comparative cross-sectional study was employed from August 01, 2020, to January 2021. A total of 124 (55 intestinal helminths-infected and 69 non-infected) newly diagnosed smear-positive pulmonary tuberculosis (PTB) patients were included in the study. A convenience sampling technique was employed to recruit study participants, and a semi-structured questionnaire was used to collect data regarding socio-demographic characteristics and possible risk factors for intestinal helminths co-infection. Stool examination was performed using both wet mount and Kato Katz technique. Additionally, weight and height measurements, sputum, and blood samples were taken to determine body mass index, bacilli load, and diabetic mellitus, respectively. Data were entered into Epi-Data software version 3.1 and analyzed using Statistical Packages for Social Sciences (SPSS) Version 25. A statistically significant difference was defined as a P-value of less than 0.05. RESULTS Intestinal helminths reduced bacilli load 3 times more than intestinal helminths non-infected PTB (AOR = 3.44; 95% CI; 1.52, 7.79; P = 0.003) However, diabetes mellitus, HIV, drinking alcohol and cigarette smoking were not associated with bacilli load. The rate of co-infection TB with intestinal helminths was 44%. The three most prevalent parasites detected were Trichuris trichiura 29 (66%), hookworm 19 (43%), and Ascaris lumbricoides 11(25%)). Among co-infected patients about 36 (81.8%) had a single parasite infection, and 19 (43.2%) had multiple infections. A body mass index < 18.5 (AOR = 3.26; 95% CI; 1.25, 8.56;P = 0.016) and untrimmed fingernail status (AOR = 3.63; 95%CI;1.32,9.93;P = 0.012) were significantly associated with PTB- intestinal helminth -co-infection. CONCLUSION Helminth infection was associated with a lower bacilli load compared to helmenths non-infected PTB. The rate of co-infection TB with intestinal helminths was 44%. Trichuris trichiura was the most prevalent helminth. Untrimmed fingernail and a body mass index were associated with PTB-intestinal helminth co-infection.
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Affiliation(s)
- Melese Mekuria
- Department of Medical Laboratory Technology, Hossana College of Health Science, Hossana, Ethiopia
| | - Gemeda Abebe
- Department of Medical Laboratory Technology, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Habtamu Hasen
- Department of Public Health, Hossana College of Health Science, Hossana, Ethiopia.
| | - Ahmed Zeynudin
- Department of Medical Laboratory Technology, College of Health Sciences, Jimma University, Jimma, Ethiopia
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Djibougou DA, Mensah GI, Kaboré A, Toé I, Sawadogo LT, Lompo PF, Kone AMM, Hien H, Meda CZ, Combary A, Bonfoh B, Addo KK, Belem AMG, Dabiré RK, Hoffmann J, Perreau M, Diagbouga PS. Immunological and Haematological Relevance of Helminths and Mycobacterium tuberculosis Complex Coinfection among Newly Diagnosed Pulmonary Tuberculosis Patients from Bobo-Dioulasso, Burkina Faso. Biomedicines 2024; 12:1472. [PMID: 39062045 PMCID: PMC11274831 DOI: 10.3390/biomedicines12071472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/08/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024] Open
Abstract
The effect of helminthiasis on host immunity is a neglected area of research, particularly in tuberculosis (TB) infection. This study aimed to evaluate the effect of helminthiasis on immunological and haematological parameters in newly diagnosed TB patients in Bobo-Dioulasso. After all biological analyses, we formed three subpopulations: group 1 (n = 82), as control, were participants without helminthic or Mycobacterium tuberculosis complex infection (Mtb-/Helm-), group 2 (n = 73) were TB patients without helminthic infection (Mtb+/Helm-), and group 3 (n = 22) were TB patients with helminthic infection (Mtb+/Helm+). The proportion of helminth coinfection was 23.16% (22/95) in TB patients, and Schistosoma mansoni infection was found in 77.3% (17/22) cases of helminthiasis observed in this study. A low CD4 T cell count and a low CD4:CD8 ratio were significantly associated with concomitant infection with helminths and the Mtb complex (Mtb+/Helm+) compared to the other groups (p < 0.05). However, there was no statistically significant difference in the CD8 median among the three participating groups (p > 0.05). Lymphopenia, monocytosis, thrombocytosis, and hypochromic microcytic anaemia were the haematological defects observed in the Mtb+/Helm+ and Mtb+/Helm- patients. Exploring these types of immune-haematological biomarkers would be a valuable aid in diagnosing and a better follow-up and monitoring of the tuberculosis-helminthiasis coinfection.
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Affiliation(s)
- Diakourga Arthur Djibougou
- Doctoral School of Natural Sciences and Agronomy, Université Nazi BONI, Bobo-Dioulasso 1091, Burkina Faso; (I.T.); (L.T.S.); (C.Z.M.); (A.M.-G.B.)
- Infectious Diseases Program, Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso 1091, Burkina Faso; (A.M.M.K.); (H.H.); (R.K.D.)
- Institut de Recherche en Sciences de la Santé, CNRST, Bobo-Dioulasso 545, Burkina Faso
| | - Gloria Ivy Mensah
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra 00233, Ghana; (G.I.M.); (K.K.A.)
| | - Achille Kaboré
- Infectious Disease and Health Systems (IDHS), FHI 360, Washington, DC 20037, USA;
| | - Inoussa Toé
- Doctoral School of Natural Sciences and Agronomy, Université Nazi BONI, Bobo-Dioulasso 1091, Burkina Faso; (I.T.); (L.T.S.); (C.Z.M.); (A.M.-G.B.)
- Institut de Recherche en Sciences de la Santé, CNRST, Bobo-Dioulasso 545, Burkina Faso
| | - Leon Tinnoga Sawadogo
- Doctoral School of Natural Sciences and Agronomy, Université Nazi BONI, Bobo-Dioulasso 1091, Burkina Faso; (I.T.); (L.T.S.); (C.Z.M.); (A.M.-G.B.)
- National Tuberculosis Programme, Ministry of Health and Public Hygiene, Ouagadougou 01 P.O. Box 690, Burkina Faso;
| | - Palpouguini Felix Lompo
- Etudes Formation et Recherches Développement en Santé (EFORDS), Ouagadougou 10 P.O. Box 13064, Burkina Faso;
| | - Amariane M. M. Kone
- Infectious Diseases Program, Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso 1091, Burkina Faso; (A.M.M.K.); (H.H.); (R.K.D.)
| | - Hervé Hien
- Infectious Diseases Program, Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso 1091, Burkina Faso; (A.M.M.K.); (H.H.); (R.K.D.)
- Institut de Recherche en Sciences de la Santé, CNRST, Bobo-Dioulasso 545, Burkina Faso
| | - Clement Ziemlé Meda
- Doctoral School of Natural Sciences and Agronomy, Université Nazi BONI, Bobo-Dioulasso 1091, Burkina Faso; (I.T.); (L.T.S.); (C.Z.M.); (A.M.-G.B.)
- Infectious Diseases Program, Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso 1091, Burkina Faso; (A.M.M.K.); (H.H.); (R.K.D.)
| | - Adjima Combary
- National Tuberculosis Programme, Ministry of Health and Public Hygiene, Ouagadougou 01 P.O. Box 690, Burkina Faso;
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifique de Côte d’Ivoire, Adiopodoumé 01 P.O. Box 1303, Côte d’Ivoire;
| | - Kennedy Kwasi Addo
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra 00233, Ghana; (G.I.M.); (K.K.A.)
| | - Adrien Marie-Gaston Belem
- Doctoral School of Natural Sciences and Agronomy, Université Nazi BONI, Bobo-Dioulasso 1091, Burkina Faso; (I.T.); (L.T.S.); (C.Z.M.); (A.M.-G.B.)
| | - Roch Konbobr Dabiré
- Infectious Diseases Program, Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso 1091, Burkina Faso; (A.M.M.K.); (H.H.); (R.K.D.)
- Institut de Recherche en Sciences de la Santé, CNRST, Bobo-Dioulasso 545, Burkina Faso
| | - Jonathan Hoffmann
- Département Médical et Scientifique, Fondation Mérieux, 17 rue Bourgelat, 69002 Lyon, France;
| | - Matthieu Perreau
- Faculty of Biology and Medicine, Université de Lausanne, 1010 Lausanne, Switzerland;
| | - Potiandi Serge Diagbouga
- Institut de Recherche en Sciences de la Santé, CNRST, Bobo-Dioulasso 545, Burkina Faso
- Etudes Formation et Recherches Développement en Santé (EFORDS), Ouagadougou 10 P.O. Box 13064, Burkina Faso;
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Belete D, Amare A, Andualem T, Kasew D, Biset S. Prevalence of Intestinal Parasitic Infections and Associated Factors among Presumptive Pulmonary Tuberculosis Patients at Debre Tabor Referral Hospital, South Gondar, Northwest Ethiopia: A Cross-Sectional Study. J Parasitol Res 2024; 2024:8993666. [PMID: 38799382 PMCID: PMC11127764 DOI: 10.1155/2024/8993666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/25/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Background In developing countries, intestinal parasitic infections (IPIs) and tuberculosis (TB) coinfections have been perceived to be high. The geographic distributions of helminths and TB overlap substantially. Parasitic infections affect the outcome of TB by changing the cell-mediated immune response to a humoral response, while Mycobacterium infection favors the immune escape of helminths. There are limited studies on the epidemiology of intestinal parasites among presumptive pulmonary TB (PTB) patients in Ethiopia. Therefore, this study is aimed at determining the prevalence of intestinal parasitic infections and associated factors among patients with presumptive pulmonary tuberculosis at Debre Tabor Referral Hospital. Methods and Materials A hospital-based cross-sectional study was conducted from March to June 2021. The sociodemographic data and associated factors were collected using a structured questionnaire, and stool samples were collected by convenient sampling technique and processed for the detection of intestinal parasites using a direct wet mount saline preparation and formal ether concentration technique. The data was coded, cleaned, and analyzed by SPSS version 23. Bivariate and multivariable analyses were conducted to determine an adjusted odds ratio (AOR). p value < 0.05 was considered statistically significant. Result The overall prevalence of intestinal parasitosis was 25.6% (81/316); of these, 12.9% (41/316) were protozoan infections and 12.7% (40/316) were helminth infections. Multivariable logistic regression analysis showed that being older than 36 years (AOR: 4.35; 95% CI: 1.26, 13.91; p = 0.001), rural residence (AOR: 3.46; 95% CI: 1.18, 9.97; p < 0.001), unable to read and write (AOR = 2.62; 95%CI = 2.15, 8.43; p = 0.004), and use of river water (AOR: 3.47; 95% CI: 1.62, 8.21; p < 0.001) were associated with intestinal parasitic infections. Conclusion The present study showed that the prevalence of intestinal parasitosis among presumptive pulmonary tuberculosis patients was high in the study area. Age, residence, educational status, and source of water were significant factors in IPIs among presumptive TB patients. Moreover, our findings suggest a proper health education program for good personal hygiene habits, the coloration of water, avoiding open-field defecation, and also preventative measures to avoid the acquisition of IPIs in patients with TB. Presumptive tuberculosis patients should be screened and treated accordingly. Additionally, it needs further research and recommends more assessment for intestinal parasitic infection in PTB patients.
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Affiliation(s)
- Debaka Belete
- University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, Gondar, Ethiopia
| | - Azanaw Amare
- University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, Gondar, Ethiopia
| | - Tesfaye Andualem
- Debre Tabor University, College of Health Sciences and School of Medicine, Department of Medical Laboratory, Debre Tabor, Ethiopia
| | - Desie Kasew
- University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, Gondar, Ethiopia
| | - Sirak Biset
- University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, Gondar, Ethiopia
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Kumari R, Muni S, Kumar R, Kumar R, Kumar A, Kumar S, Kumari N. Comparison of Cytokines Profiles and Monocyte Response Among Tuberculosis Patients Versus Patients Coinfected With Intestinal Helminth and Tuberculosis. Cureus 2024; 16:e51726. [PMID: 38318585 PMCID: PMC10839430 DOI: 10.7759/cureus.51726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
Background Tuberculosis (TB) and intestinal helminth infections often coexist, posing a significant health challenge. TB, caused by Mycobacterium tuberculosis, and helminths elicit distinct immune responses - Th1 for TB and Th2 for helminths. Co-infection introduces a complex immunological challenge, potentially compromising TB control. This study addresses the research gap by comparing cytokine profiles and monocyte responses in TB patients, helminth-infected individuals, and those with both. Insights gained may enhance diagnosis, treatment, and disease control strategies where TB and helminths prevail. Methods A cross-sectional observational study conducted at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, aimed to compare cytokine profiles and monocyte responses in TB patients and those coinfected with TB and helminths. The study included 150 newly diagnosed active TB individuals aged 18 to 65 years. TB diagnosis was confirmed through clinical assessment, sputum microscopy, and GeneXpert (Cepheid, Sunnyvale, CA, USA) testing. Stool examination employed various methods, including the Kato-Katz technique and formalin-ether concentration. Blood samples were collected for hematological analysis, cytokine profiling, and monocyte isolation. Statistical analysis, using SPSS version 20.0 (IBM Corp., Armonk, NY, USA), included descriptive statistics, and t-test analyses. Results In our study of 150 participants, half (50.0%) showed positive helminth status. The sociodemographic analysis revealed no significant differences in age, gender, education, occupation, marital status, smoking, alcohol, BMI, diabetes, and hypertension between TB patients (n=75) and TB+Helminth patients (n=75), ensuring baseline matching. The prevalence of specific helminth infections in TB+Helminth patients included Ascaris lumbricoides (24.0%), Trichuris trichiura (18.7%), and others. Hematological parameters showed significant differences, with TB+Helminth patients exhibiting higher RBC count, hemoglobin, hematocrit, neutrophil count, and monocyte count; also eosinophil count was more raised in TB+Helminth patients (0.36 x 103/μL) when compared to TB patients (0.25 x 103/μL). Cytokine profiles and monocyte responses varied significantly between the groups, with TB patients having higher IL-4, IL-6, IFN-γ, TNF-α, and IL-1β levels, while TB+Helminth patients had elevated IL-10. Monocyte response time did not differ significantly. Conclusion The observed differences in hematological parameters and cytokine profiles emphasize the need for tailored approaches to diagnosis and treatment in co-infected individuals. These findings suggest that the management of TB patients should consider the potential influence of helminth co-infections.
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Affiliation(s)
- Ritu Kumari
- Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Sweta Muni
- Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Randhir Kumar
- Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Rakesh Kumar
- Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Abay Kumar
- Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Shailesh Kumar
- Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Namrata Kumari
- Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
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Zenebe Y, Habtamu M, Abebe M, Tulu B, Atnafu A, Mekonnen D, Lang R, Munshea A. Intestinal helminth co-infection and associated factors among pulmonary tuberculosis patients in Africa and Asia: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:739. [PMID: 37899439 PMCID: PMC10614413 DOI: 10.1186/s12879-023-08716-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) and intestinal helminths have huge public health importance, and they are geographically overlapped. Data about the burden of intestinal helminth and TB co-infection in these areas are fragmented. In this systematic review and meta-analysis we compile the current literatures and generate pooled prevalence. We also identity factors associated with intestinal helminth co-infection among TB patients. METHODS Original articles published in English language up to March 23, 2022 were systematically searched from electronic database (PubMed/Medline, Scopus, Science Direct, Google Scholars and HINARI). The search was done using medical subject heading terms and keywords. Identified articles were exported into the EndNote library. The identified articles were screened using PRISMA flow diagram. Then the methodological quality of included articles was evaluated and rated using the modified version of Newcastle-Ottawa Scale. Data were extracted using Microsoft Excel. Sensitivity analysis and Egger regression test were used for the assessment of heterogeneity and publication bias. Finally the results are presented with a meta-analysis of pooled estimates, forest plots, and tables. The quantitative data were analyzed using Stata version 14. RESULTS From a total of 5457 searched articles, 22 eligible articles were included in the review. The pooled prevalence of helminth co-infection among TB cases was 29.69% (95%CI: 21.10, 38.29). TB patients were found to more frequently harbor one or more intestinal helminths than TB negative individuals (OR = 1.72 (95%CI: 1.20, 2.48)). Among the reported helminths, Schistosoma mansoni and Strongyloides stercoralis had the highest pooled prevalence among TB cases. However, unlike other individual helminths, only Strongyloides stercoralis (OR = 2.67 (95% CI, 1.20-6.76)) had significant association with TB cases compared to TB negatives. BMI was significantly associated with intestinal helminth co-infection among TB patients (OR = 2.75 (95%CI: 1.19, 6.38)). CONCLUSIONS Patients with TB have been shown to harbor co-infection with one or more intestinal helminths with considerable proportions when compared with TB-negative individuals. The higher prevalence of helminth infection in TB cases might indicate that co-infection promotes active TB disease. Thus, routine intestinal helminth screening and assessment of their nutritional status is suggested for TB patients.
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Affiliation(s)
- Yohannes Zenebe
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Bahir Dar, Ethiopia.
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | | | - Markos Abebe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Begna Tulu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abay Atnafu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Daniel Mekonnen
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Bahir Dar, Ethiopia
| | - Roland Lang
- Institute for Clinical Microbiology, Immunology and Hygiene, University Hospital of Erlangen, Friedrich-Alexander University, Erlangen-Nuremberg, Germany
| | - Abaineh Munshea
- Health Biotechnology Division, Institute of Biotechnology, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Biology, Science College, Bahir Dar University, Bahir Dar, Ethiopia
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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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Kiflie A, Bewket G, Tajebe F, Abate E, Schӧn T, Blomgran R. Helminth species-specific effects on IFN-γ producing T cells during active and latent tuberculosis. PLoS Negl Trop Dis 2023; 17:e0011094. [PMID: 36662839 PMCID: PMC9891516 DOI: 10.1371/journal.pntd.0011094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/01/2023] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Interferon-γ (IFN-γ) is a key cytokine inducing protective immune responses during tuberculosis (TB) infection. Helminth-induced immune responses may affect IFN-γ production by T cells, although its connection with disease severity and immune recovery during treatment is unexplored. We investigated the species-specific effect of helminths on the IFN-γ production by T cells in relation to disease severity during active and latent TB infection (LTBI). METHODS In this study, 69 active pulmonary TB patients (PTB), 28 with LTBI and 66 healthy controls were included. Active TB was diagnosed using GenXpert MTB/RIF while QuantiFERON test (QFT) was used for the screening of healthy community controls (CCs) and for the diagnosis of LTBI. Helminth infection was identified by routine diagnosis whereas clinical disease severity was evaluated by the TB score. Intracellular IFN-γ production of T cells in stimulated peripheral blood mononuclear cells (PBMCs) was analyzed by flow cytometry using TB antigens (PPD), the polyclonal T cell activator staphylococcal enterotoxin B (SEB), or medium as unstimulated control. RESULTS Helminth infected CCs and LTBI subjects showed a significant reduction of IFN-γ+ CD4+ T cells by PPD-stimulation compared to non-helminth infected control groups. The significant reduction in the frequency of IFN-γ+ T cells in both latent and active PTB patients following SEB stimulation was mostly attributed to Schistosoma mansoni infection, whereas Ascaris lumbricoides, Schistosoma mansoni, and hookworm infection contributed equally in CCs. Following anti-helminthic and anti-TB treatment for 2 months, the frequency of IFN-γ+ CD4 T cells in helminth coinfected PTB was restored to levels of helminth negative PTB before treatment. Helminth coinfected PTB patients with an intermediate and severe clinical course had reduced capacity for production of IFN-γ+ T cells compared to the corresponding non-helminth infected PTB. CONCLUSION We found a reduction in IFN-γ producing T cells by helminth coinfection which was restored following anti-helminthic treatment. This reduction was helminth species-dependent in an exploratory sub-analysis and correlated to increased disease severity.
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Affiliation(s)
- Amare Kiflie
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia
| | - Gezahegn Bewket
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia
| | - Fitsumbrhan Tajebe
- Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia
| | - Ebba Abate
- The Ohio State, Global One Health, Addis Ababa, Ethiopia
| | - Thomas Schӧn
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linkӧping University, Linkӧping, Sweden
- Department of Infectious Diseases, Kalmar County Hospital, Linkӧping University, Linkӧping, Sweden
- Department of Infectious Diseases, County of Östergötland, Linkӧping University Hospital, Linkӧping University, Linkӧping, Sweden
| | - Robert Blomgran
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linkӧping University, Linkӧping, Sweden
- * E-mail:
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Chin KL, Fonte L, Lim BH, Sarmiento ME, Acosta A. Immunomodulation resulting of helminth infection could be an opportunity for immunization against tuberculosis and mucosal pathogens. Front Immunol 2023; 14:1091352. [PMID: 37020538 PMCID: PMC10067736 DOI: 10.3389/fimmu.2023.1091352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/08/2023] [Indexed: 04/07/2023] Open
Affiliation(s)
- Kai Ling Chin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- *Correspondence: Kai Ling Chin, ; Luis Fonte, ; Armando Acosta,
| | - Luis Fonte
- Department of Parasitology, Institute of Tropical Medicine “Pedro Kourí”, Havana, Cuba
- *Correspondence: Kai Ling Chin, ; Luis Fonte, ; Armando Acosta,
| | - Boon Huat Lim
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Maria E. Sarmiento
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Armando Acosta
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- *Correspondence: Kai Ling Chin, ; Luis Fonte, ; Armando Acosta,
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Schick J, Altunay M, Lacorcia M, Marschner N, Westermann S, Schluckebier J, Schubart C, Bodendorfer B, Christensen D, Alexander C, Wirtz S, Voehringer D, da Costa CP, Lang R. IL-4 and helminth infection downregulate MINCLE-dependent macrophage response to mycobacteria and Th17 adjuvanticity. eLife 2023; 12:72923. [PMID: 36753434 PMCID: PMC9908076 DOI: 10.7554/elife.72923] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
The myeloid C-type lectin receptor (CLR) MINCLE senses the mycobacterial cell wall component trehalose-6,6'-dimycolate (TDM). Recently, we found that IL-4 downregulates MINCLE expression in macrophages. IL-4 is a hallmark cytokine in helminth infections, which appear to increase the risk for mycobacterial infection and active tuberculosis. Here, we investigated functional consequences of IL-4 and helminth infection on MINCLE-driven macrophage activation and Th1/Th17 adjuvanticity. IL-4 inhibited MINCLE and cytokine induction after macrophage infection with Mycobacterium bovis bacille Calmette-Guerin (BCG). Infection of mice with BCG upregulated MINCLE on myeloid cells, which was inhibited by IL-4 plasmid injection and by infection with the nematode Nippostrongylus brasiliensis in monocytes. To determine the impact of helminth infection on MINCLE-dependent immune responses, we vaccinated mice with a recombinant protein together with the MINCLE ligand trehalose-6,6-dibehenate (TDB) as adjuvant. Concurrent infection with N. brasiliensis or with Schistosoma mansoni promoted T cell-derived IL-4 production and suppressed Th1/Th17 differentiation in the spleen. In contrast, helminth infection did not reduce Th1/Th17 induction by TDB in draining peripheral lymph nodes, where IL-4 levels were unaltered. Upon use of the TLR4-dependent adjuvant G3D6A, N. brasiliensis infection impaired selectively the induction of splenic antigen-specific Th1 but not of Th17 cells. Inhibition of MINCLE-dependent Th1/Th17 responses in mice infected with N. brasiliensis was dependent on IL-4/IL-13. Thus, helminth infection attenuated the Th17 response to MINCLE-dependent immunization in an organ- and adjuvant-specific manner via the Th2 cytokines IL-4/IL-13. Taken together, our results demonstrate downregulation of MINCLE expression on monocytes and macrophages by IL-4 as a possible mechanism of thwarted Th17 vaccination responses by underlying helminth infection.
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Affiliation(s)
- Judith Schick
- Institut für Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-NürnbergErlangenGermany
| | - Meltem Altunay
- Institut für Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-NürnbergErlangenGermany
| | - Matthew Lacorcia
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Center for Global Health, Technische Universität MünchenMunichGermany,Center for Global Health, Technical University MunichMunichGermany
| | - Nathalie Marschner
- Institut für Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-NürnbergErlangenGermany
| | - Stefanie Westermann
- Infektionsbiologische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-NürnbergErlangenGermany
| | - Julia Schluckebier
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Center for Global Health, Technische Universität MünchenMunichGermany,Center for Global Health, Technical University MunichMunichGermany
| | - Christoph Schubart
- Infektionsbiologische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-NürnbergErlangenGermany
| | - Barbara Bodendorfer
- Institut für Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-NürnbergErlangenGermany
| | - Dennis Christensen
- Adjuvant Research, Department of Infectious Disease Immunology, Statens Serum InstitutCopenhagenDenmark
| | - Christian Alexander
- Cellular Microbiology, Forschungszentrum Borstel, Leibniz Lung Center BorstelBorstelGermany
| | - Stefan Wirtz
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-NürnbergErlangenGermany
| | - David Voehringer
- Infektionsbiologische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-NürnbergErlangenGermany
| | - Clarissa Prazeres da Costa
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Center for Global Health, Technische Universität MünchenMunichGermany,Center for Global Health, Technical University MunichMunichGermany
| | - Roland Lang
- Institut für Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-NürnbergErlangenGermany
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10
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Immunological Interactions between Intestinal Helminth Infections and Tuberculosis. Diagnostics (Basel) 2022; 12:diagnostics12112676. [PMID: 36359526 PMCID: PMC9689268 DOI: 10.3390/diagnostics12112676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/13/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Helminth infections are among the neglected tropical diseases affecting billions of people globally, predominantly in developing countries. Helminths’ effects are augmented by coincident tuberculosis disease, which infects a third of the world’s population. The role of helminth infections on the pathogenesis and pathology of active tuberculosis (T.B.) remains controversial. Parasite-induced suppression of the efficacy of Bacille Calmette-Guerin (BCG) has been widely reported in helminth-endemic areas worldwide. T.B. immune response is predominantly proinflammatory T-helper type 1 (Th1)-dependent. On the other hand, helminth infections induce an opposing anti-inflammatory Th2 and Th3 immune-regulatory response. This review summarizes the literature focusing on host immune response profiles during single-helminth, T.B. and dual infections. It also aims to necessitate investigations into the complexity of immunity in helminth/T.B. coinfected patients since the research data are limited and contradictory. Helminths overlap geographically with T.B., particularly in Sub-Saharan Africa. Each disease elicits a response which may skew the immune responses. However, these effects are helminth species-dependent, where some parasites have no impact on the immune responses to concurrent T.B. The implications for the complex immunological interactions that occur during coinfection are highlighted to inform government treatment policies and encourage the development of high-efficacy T.B. vaccines in areas where helminths are prevalent.
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11
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Prevalence of Intestinal Helminths among Cancer Patients Who Are under Chemotherapy at the University of Gondar Comprehensive Specialized Hospital Oncology Clinic, Northwest Ethiopia. J Cancer Epidemiol 2022; 2022:4484183. [PMID: 35480628 PMCID: PMC9038382 DOI: 10.1155/2022/4484183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background In developing countries, environmental and personal hygiene is playing a great role in the increasing of intestinal helminth infection. In countries with limited resources and poor hygiene practices, there is a substantial overlap of intestinal helminthic and chronic infections like HIV, TB, and cancer. Intestinal helminths like Ascaris lumbricoides, Trichuris trichiura, and hookworm cause malnutrition and induce a type-2 immune response that could worsen the severity and clinical outcomes of patients with cancer. Our aim was to determine the prevalence of intestinal helminths among cancer patients who are under chemotherapy. Methodology. A prospective cross-sectional study was conducted in volunteer cancer patients. Clinical information were collected from study participants using a structured questioner. Stool sample was collected for parasitological examination. Formol-ether concentration technique was done, and then, two microscopic slides were prepared. Examination was done by two laboratory technicians for the detection of helminths. SPSS version 22 was used for data analysis, and simple descriptive statistical analysis was done for data presentation. Result The total study participants were 41, of these 31 (75.6%) were females and 10 (24.4%) were male. Breast cancer and colonic cancer were the highest proportion with the others, 43.9% and 17.1%, respectively. The prevalence of intestinal parasites were 7/41 (17%). Hookworm 3/41(7.3%), Ascaris lumbricoides 3/41(7.3%), and Hymenolepis nana 1/41(2.4%) are the isolated parasite. Conclusions and Recommendations. The prevalence of intestinal helminths in cancer is lower than HIV and DM in the study area. However, the prevalence in these cancer patients is still high and needs deworming and health education for the better management of these cancer patients.
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12
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Karo-Atar D, Khan N, Divangahi M, King IL. Helminth-mediated disease tolerance in TB: A role for microbiota? PLoS Pathog 2021; 17:e1009690. [PMID: 34265025 PMCID: PMC8282059 DOI: 10.1371/journal.ppat.1009690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Danielle Karo-Atar
- Meakins-Christie Laboratories, Department of Microbiology and Immunology, McGill University Health Centre, Quebec, Canada
| | - Nargis Khan
- Meakins-Christie Laboratories, Departments of Medicine, Microbiology and Immunology, Pathology McGill University, McGill International TB Centre, McGill University Health Centre, Quebec, Canada
| | - Maziar Divangahi
- Meakins-Christie Laboratories, Departments of Medicine, Microbiology and Immunology, Pathology McGill University, McGill International TB Centre, McGill University Health Centre, Quebec, Canada
- * E-mail: (MD); (ILK)
| | - Irah L. King
- Meakins-Christie Laboratories, Department of Microbiology and Immunology, McGill University Health Centre, Quebec, Canada
- McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, Quebec, Canada
- * E-mail: (MD); (ILK)
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13
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Effect of Helicobacter pylori and Helminth Coinfection on the Immune Response to Mycobacterium tuberculosis. Curr Microbiol 2021; 78:3351-3371. [PMID: 34251513 DOI: 10.1007/s00284-021-02604-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/30/2021] [Indexed: 02/07/2023]
Abstract
Tuberculosis remains one of the main causes of morbidity and mortality worldwide despite decades of efforts to eradicate the disease. Although the immune response controls the infection in most infected individuals (90%), the ability of the bacterium to persist throughout the host's life leads to a risk of reactivation. Underlying conditions including human immunodeficiency virus (HIV) infection, organ transplantation, and immunosuppressive therapies are considered risk factors for progression to active disease. However, many individuals infected with Mycobacterium tuberculosis may develop clinical disease in the absence of underlying immunosuppression. It is also possible that unknown conditions may drive the progression to disease. The human microbiota can be an important modulator of the immune system; it can not only trigger inflammatory disorders, but also drive the response to other infectious diseases. In developing countries, chronic mucosal infections with Helicobacter pylori and helminths may be particularly important, as these infections frequently coexist throughout the host's life. However, little is known about the interactions of these pathogens with the immune system and their effects on M. tuberculosis clinical disease, if any. In this review, we discuss the potential effects of H. pylori and helminth co-infections on the immune response to M. tuberculosis. This may contribute to our understanding of host-pathogen interactions and in designing new strategies for the prevention and control of tuberculosis.
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14
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Natural resistance to worms exacerbates bovine tuberculosis severity independently of worm coinfection. Proc Natl Acad Sci U S A 2021; 118:2015080118. [PMID: 33431676 DOI: 10.1073/pnas.2015080118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pathogen interactions arising during coinfection can exacerbate disease severity, for example when the immune response mounted against one pathogen negatively affects defense of another. It is also possible that host immune responses to a pathogen, shaped by historical evolutionary interactions between host and pathogen, may modify host immune defenses in ways that have repercussions for other pathogens. In this case, negative interactions between two pathogens could emerge even in the absence of concurrent infection. Parasitic worms and tuberculosis (TB) are involved in one of the most geographically extensive of pathogen interactions, and during coinfection worms can exacerbate TB disease outcomes. Here, we show that in a wild mammal natural resistance to worms affects bovine tuberculosis (BTB) severity independently of active worm infection. We found that worm-resistant individuals were more likely to die of BTB than were nonresistant individuals, and their disease progressed more quickly. Anthelmintic treatment moderated, but did not eliminate, the resistance effect, and the effects of resistance and treatment were opposite and additive, with untreated, resistant individuals experiencing the highest mortality. Furthermore, resistance and anthelmintic treatment had nonoverlapping effects on BTB pathology. The effects of resistance manifested in the lungs (the primary site of BTB infection), while the effects of treatment manifested almost entirely in the lymph nodes (the site of disseminated disease), suggesting that resistance and active worm infection affect BTB progression via distinct mechanisms. Our findings reveal that interactions between pathogens can occur as a consequence of processes arising on very different timescales.
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15
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Bok J, Hofland RW, Evans CA. Whole Blood Mycobacterial Growth Assays for Assessing Human Tuberculosis Susceptibility: A Systematic Review and Meta-Analysis. Front Immunol 2021; 12:641082. [PMID: 34046032 PMCID: PMC8144701 DOI: 10.3389/fimmu.2021.641082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/08/2021] [Indexed: 01/20/2023] Open
Abstract
Background Whole blood mycobacterial growth assays (WBMGA) quantify mycobacterial growth in fresh blood samples and may have potential for assessing tuberculosis vaccines and identifying individuals at risk of tuberculosis. We evaluated the evidence for the underlying assumption that in vitro WBMGA results can predict in vivo tuberculosis susceptibility. Methods A systematic search was done for studies assessing associations between WBMGA results and tuberculosis susceptibility. Meta-analyses were performed for eligible studies by calculating population-weighted averages. Results No studies directly assessed whether WBMGA results predicted tuberculosis susceptibility. 15 studies assessed associations between WBMGA results and proven correlates of tuberculosis susceptibility, which we divided in two categories. Firstly, WBMGA associations with factors believed to reduce tuberculosis susceptibility were statistically significant in all eight studies of: BCG vaccination; vitamin D supplementation; altitude; and HIV-negativity/therapy. Secondly, WBMGA associations with probable correlates of tuberculosis susceptibility were statistically significant in three studies of tuberculosis disease, in a parasitism study and in two of the five studies of latent tuberculosis infection. Meta-analyses for associations between WBMGA results and BCG vaccination, tuberculosis infection, tuberculosis disease and HIV infection revealed consistent effects. There was considerable methodological heterogeneity. Conclusions The study results generally showed significant associations between WBMGA results and correlates of tuberculosis susceptibility. However, no study directly assessed whether WBMGA results predicted actual susceptibility to tuberculosis infection or disease. We recommend optimization and standardization of WBMGA methodology and prospective studies to determine whether WBMGA predict susceptibility to tuberculosis disease.
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Affiliation(s)
- Jeroen Bok
- Department of Infectious Disease, Imperial College London, London, United Kingdom.,Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovacion Por la Salud Y el Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru.,Department of Pulmonology and Tuberculosis, University Medical Center Utrecht, Utrecht, Netherlands
| | - Regina W Hofland
- Department of Pulmonology and Tuberculosis, University Medical Center Utrecht, Utrecht, Netherlands
| | - Carlton A Evans
- Department of Infectious Disease, Imperial College London, London, United Kingdom.,Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovacion Por la Salud Y el Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Peru
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16
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Kumar NP, Kathamuthu GR, Moideen K, Banurekha VV, Nair D, Fay MP, Nutman TB, Babu S. Strongyloides stercoralis Coinfection Is Associated With Greater Disease Severity, Higher Bacterial Burden, and Elevated Plasma Matrix Metalloproteinases in Pulmonary Tuberculosis. J Infect Dis 2021; 222:1021-1026. [PMID: 32307511 DOI: 10.1093/infdis/jiaa194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Helminths and tuberculosis (TB) largely overlap at the population level. Whether helminth infections influence disease severity and bacterial burdens in TB is not well understood. METHODS This study was conducted to examine the disease severity in a cohort of pulmonary TB (PTB) individuals with (Ss+) or without (Ss-) seropositivity for Strongyloides stercoralis infection. RESULTS Ss+ was associated with increased risk of cavitation (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.33-9.04; P < .0001) and bilateral lung involvement (OR, 5.97; 95% CI, 3.03-12.09; P < .0001) in PTB individuals. Ss+ was also associated with higher bacterial burdens (OR, 7.57; 95% CI, 4.18-14.05; P < .0001) in PTB individuals. After multivariate analysis adjusting for covariates, Ss+ was still associated with greater risk of cavitation (adjusted OR [aOR], 3.99; 95% CI, 1.73-9.19; P = .0014), bilateral lung involvement (aOR, 4.09; 95% CI, 1.78-9.41; P = .0011), and higher bacterial burden (aOR, 9.32; 95% CI, 6.30-13.96; P < .0001). Finally, Ss+ was also associated with higher plasma levels of matrix metalloproteinases ([MMP]-1, -2, -7, -8, and -9) in PTB individuals. CONCLUSIONS Therefore, our data demonstrate that coexistent Ss infection is associated with greater disease severity and higher bacterial burden in PTB. Our data also demonstrate enhanced plasma levels of MMPs in coinfected individuals, suggesting a plausible biological mechanism for these effects.
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Affiliation(s)
- Nathella P Kumar
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | - Gokul R Kathamuthu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | - Kadar Moideen
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | | | - Dina Nair
- National Institute for Research in Tuberculosis, Chennai, India
| | - Michael P Fay
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Subash Babu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India.,Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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17
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Syal A, Arya Y, Hapani NN, Gupta M, Gaba S. Helminthic Infection in the Background of Active Pulmonary Tuberculosis: An Underreported Co-infection. Cureus 2021; 13:e13741. [PMID: 33842119 PMCID: PMC8022635 DOI: 10.7759/cureus.13741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Helminthic infections are widely prevalent in resource-poor countries. Tuberculosis, a disease contributing significantly to morbidity and mortality in endemic areas, often co-exists with helminthic infections. Poor living standards predispose to both of them. Moreover, untreated helminthic infection enhances the deleterious impact of tuberculosis, largely through immunological alteration. We are reporting the case of a 22-year-old male who presented with a month-long history of abdominal pain, nausea, vomiting, fever and cough complicated by hemoptysis, along with an episode of the passage of a worm in the vomitus. A thorough workup revealed active pulmonary tuberculosis co-existing with intestinal ascariasis. Anti-helminthic therapy was initiated along with anti-tubercular therapy, leading to significant improvement.
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Affiliation(s)
- Arshi Syal
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Yajur Arya
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Nikita N Hapani
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Monica Gupta
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND
| | - Saurabh Gaba
- Internal Medicine, Government Medical College and Hospital, Chandigarh, IND
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18
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Helminth species specific expansion and increased TNF-alpha production of non-classical monocytes during active tuberculosis. PLoS Negl Trop Dis 2021; 15:e0009194. [PMID: 33651797 PMCID: PMC7954301 DOI: 10.1371/journal.pntd.0009194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/12/2021] [Accepted: 02/02/2021] [Indexed: 12/26/2022] Open
Abstract
Both Mycobacterium tuberculosis infection and helminths may affect innate immune mechanisms such as differential effects on monocytes towards the non-classical and intermediate subsets that favor bacterial persistence. Our aim, was to investigate helminth species specific effects on the frequency and functional activity of monocyte subsets in patients with active tuberculosis and healthy subjects. HIV-negative patients with active pulmonary tuberculosis (PTB) and community controls (CCs) in Gondar, Ethiopia were screened for helminth infection by stool microscopy. Flow cytometric analysis of peripheral blood mononuclear cells (PBMCs) and ex vivo stimulation with purified protein derivative (PPD) and helminth antigens were used to characterize the distribution of monocyte subsets and their function. A total of 74 PTB patients and 57 CCs with and without helminth infection were included. Non-classical monocytes were increased in PTB patients with Ascaris and hookworm infection but not in Schistosoma-infected patients. Ascaris had the strongest effect in increasing the frequency of non-classical monocytes in both PTB patients and CCs, whereas PTB without helminth infection did not affect the frequency of monocyte subsets. There was a helminth specific increase in the frequency of TNF-α producing non-classical monocytes in hookworm infected PTB patients, both with and without PPD-stimulation. Low-to-intermediate TB disease severity associated with increased frequency of non-classical monocytes only for helminth-positive PTB patients, and the frequency of TNF-α producing monocytes were significantly higher in intermediate and non-classical monocytes of helminth positive PTB patients with an intermediate disease score. Helminth infection affected the frequency of monocyte subsets and function both in TB patients and controls which was helminth species dependent in TB patients. The clinical role of this potential immunomodulatory effect needs further study and may affect the response and protection to tuberculosis in areas where helminth infections are endemic.
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19
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McLaughlin TA, Nizam A, Hayara FO, Ouma GS, Campbell A, Khayumbi J, Ongalo J, Ouma SG, Shah NS, Altman JD, Kaushal D, Rengarajan J, Ernst JD, Blumberg HM, Waller LA, Gandhi NR, Day CL, Benkeser D. Schistosoma mansoni Infection Is Associated With a Higher Probability of Tuberculosis Disease in HIV-Infected Adults in Kenya. J Acquir Immune Defic Syndr 2021; 86:157-163. [PMID: 33074856 PMCID: PMC8284023 DOI: 10.1097/qai.0000000000002536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Helminth infections can modulate immunity to Mycobacterium tuberculosis (Mtb). However, the effect of helminths, including Schistosoma mansoni (SM), on Mtb infection outcomes is less clear. Furthermore, HIV is a known risk factor for tuberculosis (TB) disease and has been implicated in SM pathogenesis. Therefore, it is important to evaluate whether HIV modifies the association between SM and Mtb infection. SETTING HIV-infected and HIV-uninfected adults were enrolled in Kisumu County, Kenya, between 2014 and 2017 and categorized into 3 groups based on Mtb infection status: Mtb-uninfected healthy controls, latent TB infection (LTBI), and active TB disease. Participants were subsequently evaluated for infection with SM. METHODS We used targeted minimum loss estimation and super learning to estimate a covariate-adjusted association between SM and Mtb infection outcomes, defined as the probability of being Mtb-uninfected healthy controls, LTBI, or TB. HIV status was evaluated as an effect modifier of this association. RESULTS SM was not associated with differences in baseline demographic or clinical features of participants in this study, nor with additional parasitic infections. Covariate-adjusted analyses indicated that infection with SM was associated with a 4% higher estimated proportion of active TB cases in HIV-uninfected individuals and a 14% higher estimated proportion of active TB cases in HIV-infected individuals. There were no differences in estimated proportions of LTBI cases. CONCLUSIONS We provide evidence that SM infection is associated with a higher probability of active TB disease, particularly in HIV-infected individuals.
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Affiliation(s)
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | | | - Gregory Sadat Ouma
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Angela Campbell
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Jeremiah Khayumbi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Joshua Ongalo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Samuel Gurrion Ouma
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - N. Sarita Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - John D. Altman
- Emory Vaccine Center, Emory University, Atlanta, GA USA
- Department of Microbiology & Immunology, Emory University School of Medicine, Atlanta, GA USA
| | - Deepak Kaushal
- Southwest National Primate Research Center, Texas Biomedical Research Center, San Antonio, TX
| | - Jyothi Rengarajan
- Emory Vaccine Center, Emory University, Atlanta, GA USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Joel D. Ernst
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, CA USA
| | - Henry M. Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Lance A. Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Neel R. Gandhi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Cheryl L. Day
- Emory Vaccine Center, Emory University, Atlanta, GA USA
- Department of Microbiology & Immunology, Emory University School of Medicine, Atlanta, GA USA
| | - David Benkeser
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA USA
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Affiliation(s)
- Andrew R DiNardo
- From the Global Tuberculosis Program, William T. Shearer Center for Human Immunobiology, Texas Children's Hospital (A.R.D.), the Immigrant and Global Health Program, Department of Pediatrics (A.R.D.), and the Departments of Medicine and Molecular Virology and Microbiology (D.M.M.), Baylor College of Medicine, and the Medical Care Line, Infectious Disease Section, Michael E. DeBakey Veterans Affairs Medical Center (D.M.M.) - all in Houston; the Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands (M.G.N.); and the Department of Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany (M.G.N.)
| | - Mihai G Netea
- From the Global Tuberculosis Program, William T. Shearer Center for Human Immunobiology, Texas Children's Hospital (A.R.D.), the Immigrant and Global Health Program, Department of Pediatrics (A.R.D.), and the Departments of Medicine and Molecular Virology and Microbiology (D.M.M.), Baylor College of Medicine, and the Medical Care Line, Infectious Disease Section, Michael E. DeBakey Veterans Affairs Medical Center (D.M.M.) - all in Houston; the Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands (M.G.N.); and the Department of Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany (M.G.N.)
| | - Daniel M Musher
- From the Global Tuberculosis Program, William T. Shearer Center for Human Immunobiology, Texas Children's Hospital (A.R.D.), the Immigrant and Global Health Program, Department of Pediatrics (A.R.D.), and the Departments of Medicine and Molecular Virology and Microbiology (D.M.M.), Baylor College of Medicine, and the Medical Care Line, Infectious Disease Section, Michael E. DeBakey Veterans Affairs Medical Center (D.M.M.) - all in Houston; the Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands (M.G.N.); and the Department of Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany (M.G.N.)
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21
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Brosschot TP, Lawrence KM, Moeller BE, Kennedy MHE, FitzPatrick RD, Gauthier CM, Shin D, Gatti DM, Conway KME, Reynolds LA. Impaired host resistance to Salmonella during helminth co-infection is restored by anthelmintic treatment prior to bacterial challenge. PLoS Negl Trop Dis 2021; 15:e0009052. [PMID: 33471793 PMCID: PMC7850471 DOI: 10.1371/journal.pntd.0009052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 02/01/2021] [Accepted: 12/08/2020] [Indexed: 12/29/2022] Open
Abstract
Intestinal helminth infection can impair host resistance to co-infection with enteric bacterial pathogens. However, it is not known whether helminth drug-clearance can restore host resistance to bacterial infection. Using a mouse helminth-Salmonella co-infection system, we show that anthelmintic treatment prior to Salmonella challenge is sufficient to restore host resistance to Salmonella. The presence of the small intestine-dwelling helminth Heligmosomoides polygyrus at the point of Salmonella infection supports the initial establishment of Salmonella in the small intestinal lumen. Interestingly, if helminth drug-clearance is delayed until Salmonella has already established in the small intestinal lumen, anthelmintic treatment does not result in complete clearance of Salmonella. This suggests that while the presence of helminths supports initial Salmonella colonization, helminths are dispensable for Salmonella persistence in the host small intestine. These data contribute to the mechanistic understanding of how an ongoing or prior helminth infection can affect pathogenic bacterial colonization and persistence in the mammalian intestine. In regions where helminth infection is common and sanitation standards are poor, people are at a high risk of exposure to bacterial pathogens. Previous work in animal models has shown that helminth infection can impair host resistance to bacterial infection. The current treatment for helminth infection is the administration of helminth-clearing drugs, yet it is not known whether drug clearance of helminths restores helminth-impaired host resistance to bacterial infection. In this report we use a mouse helminth-Salmonella co-infection model system, where we find that the presence of small intestinal helminths at the point of Salmonella infection aids the establishment of Salmonella in the small intestinal lumen. We show that helminth drug clearance prior to Salmonella infection is sufficient to restore host resistance to Salmonella. However, if helminth drug clearance is delayed until after Salmonella had already established in the small intestinal lumen, helminth elimination does not result in complete clearance of Salmonella from this site. Our work suggests that helminth drug clearance may be beneficial in reducing susceptibility to subsequent intestinal bacterial infections, but that helminth drug clearance after co-infection may not result in clearance of bacterial populations that have firmly established in the intestinal lumen.
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Affiliation(s)
- Tara P Brosschot
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
| | - Katherine M Lawrence
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
| | - Brandon E Moeller
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
| | - Mia H E Kennedy
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
| | - Rachael D FitzPatrick
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
| | - Courtney M Gauthier
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
| | - Dongju Shin
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
| | - Dominique M Gatti
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
| | - Kate M E Conway
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
| | - Lisa A Reynolds
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
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22
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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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23
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Taghipour A, Tabarsi P, Sohrabi MR, Riahi SM, Rostami A, Mirjalali H, Malih N, Haghighi A. Frequency, associated factors and clinical symptoms of intestinal parasites among tuberculosis and non-tuberculosis groups in Iran: a comparative cross-sectional study. Trans R Soc Trop Med Hyg 2020; 113:234-241. [PMID: 30624729 DOI: 10.1093/trstmh/try140] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/14/2018] [Accepted: 12/16/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Co-infection of human tuberculosis (TB) and intestinal parasites infections (IPIs) is a public health problem, especially in low- and middle-income countries. There is no data on this issue in Iran. Therefore, we investigated the prevalence of IPIs among patients with TB in Iran. METHODS Stool samples were collected from 161 patients with TB and 181 healthy people (non-TB group). Standard parasitological methods including direct slide smear, formalin-ether concentration, trichrome, modified Ziehl-Neelsen and chromotrope 2R staining techniques were used for detection of intestinal protozoa and helminths. Nested-PCR and sequence analysis were used to identify the genotypes of Cryptosporidium and human-infecting species of microsporidia. Data analysis was performed using SPSS version 16. RESULTS The frequency of IPIs in the non-TB group (16.5%) was slightly lower than in patients with TB (21.1%), although statistical significance was not observed (OR, 0.74; 95% CI, 0.43-1.27; P= 0.28). Blastocystis (11.8%) was the most common parasite detected in patients with TB. Infection with multiple parasites in the non-TB group (2.2%) was significantly lower than in patients with TB (7.5%) (OR, 0.28; 95% CI, 0.08-0.88; P=0.02). The ova of Taenia spp., Ascaris lumbricoides and Hyamenolepis nana were identified in three patients with TB (1.9%), while only one person (0.5%) in the non-TB group was infected with Enterobius vermicularis. The results of genotyping revealed two C. parvum subtype families (IIa and IId) and three E. bieneusi genotypes (Ebcar4, IH and jLD-1). CONCLUSION Our results showed a higher prevalence of IPIs in patients with TB in comparison with non-TB subjects. Moreover, our findings suggest a proper health education program for good personal hygiene habits, and also preventative measures to avoid the acquisition of IPIs in patients with TB.
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Affiliation(s)
- Ali Taghipour
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Payam Tabarsi
- Department of Infectious Diseases, Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Sohrabi
- Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Riahi
- Social Determinants of Health Research Center, Department of Epidemiology and Biostatistics, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hamed Mirjalali
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Malih
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Haghighi
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
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24
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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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25
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Cadmus SI, Akinseye VO, Taiwo BO, Pinelli EO, van Soolingen D, Rhodes SG. Interactions between helminths and tuberculosis infections: Implications for tuberculosis diagnosis and vaccination in Africa. PLoS Negl Trop Dis 2020; 14:e0008069. [PMID: 32498074 PMCID: PMC7272205 DOI: 10.1371/journal.pntd.0008069] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Africa is the second most populous continent and has perennial health challenges. Of the estimated 181 million school aged children in sub-Saharan Africa (SSA), nearly half suffer from ascariasis, trichuriasis, or a combination of these infections. Coupled with these is the problem of tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) infection, which is a leading cause of death in the region. Compared to the effect of the human immunodeficiency virus on the development of TB, the effect of chronic helminth infections is a neglected area of research, yet helminth infections are as ubiquitous as they are varied and may potentially have profound effects upon host immunity, particularly as it relates to TB infection, diagnosis, and vaccination. Protection against active TB is known to require a clearly delineated T-helper type 1 (Th1) response, while helminths induce a strong opposing Th2 and immune-regulatory host response. This Review highlights the potential challenges of helminth-TB co-infection in Africa and the need for further research.
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Affiliation(s)
- Simeon I. Cadmus
- Depeartment of Veterinary Public Health & Preventive Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Control and Prevention of Zoonoses, University of Ibadan, Ibadan, Nigeria
| | - Victor O. Akinseye
- Depeartment of Veterinary Public Health & Preventive Medicine, University of Ibadan, Ibadan, Nigeria
| | - Babafemi O. Taiwo
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Elena O. Pinelli
- Center for Infectious Disease Control Netherlands (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Dick van Soolingen
- Center for Infectious Disease Control Netherlands (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Medical Microbiology, Radboud University Medical Center Nijmegen, the Netherlands
| | - Shelley G. Rhodes
- TB Research Group, Animal and Plant Health Agency, Surrey, United Kingdom
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Rajamanickam A, Munisankar S, Dolla C, Menon PA, Nutman TB, Babu S. Helminth Coinfection Alters Monocyte Activation, Polarization, and Function in Latent Mycobacterium tuberculosis Infection. THE JOURNAL OF IMMUNOLOGY 2020; 204:1274-1286. [PMID: 31953351 DOI: 10.4049/jimmunol.1901127] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/19/2019] [Indexed: 12/21/2022]
Abstract
Helminth infections are known to influence T and B cell responses in latent tuberculosis infection (LTBI). Whether helminth infections also modulate monocyte responses in helminth-LTBI coinfection has not been fully explored. To this end, we examined the activation, polarization, and function of human monocytes isolated from individuals with LTBI with (n = 25) or without (n = 25) coincident Strongyloides stercoralis infection (S. stercoralis-positive and S. stercoralis-negative respectively). Our data reveal that the presence of S. stercoralis infection is associated with lower frequencies of monocytes expressing CD54, CD80, CD86 at baseline (absence of stimulation) and in response to mycobacterial-Ag stimulation than monocytes from S. stercoralis-negative individuals. In contrast, S. stercoralis infection was associated with higher frequencies of M2-like monocytes, as determined by expression of CD206 and CD163. Monocytes from S. stercoralis-positive individuals had a reduced capacity to phagocytose or exhibit respiratory burst activity following mycobacterial-Ag or LPS stimulation and were less capable of expression of IL-1β, TNF-α, IL-6, and IL-12 at baseline and/or following Ag stimulation compared with those without S. stercoralis infection. In addition, definitive treatment of S. stercoralis infection resulted in a significant reversal of the altered monocyte function 6 mo after anthelmintic therapy. Finally, T cells from S. stercoralis-positive individuals exhibited significantly lower activation at baseline or following mycobacterial-Ag stimulation. Therefore, our data highlight the induction of dampened monocyte activation, enhanced M2 polarization, and impaired monocyte function in helminth-LTBI coinfection. Our data also reveal a different mechanism by which helminth infection modulates immune function in LTBI.
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Affiliation(s)
- Anuradha Rajamanickam
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India
| | - Saravanan Munisankar
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India
| | - Chandrakumar Dolla
- National Institute for Research in Tuberculosis, Chennai 600031, India; and
| | - Pradeep A Menon
- National Institute for Research in Tuberculosis, Chennai 600031, India; and
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Subash Babu
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai 600031, India; .,Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
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Seddon JA, Tugume L, Solomons R, Prasad K, Bahr NC. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome Open Res 2019; 4:167. [PMID: 32118118 PMCID: PMC7029758 DOI: 10.12688/wellcomeopenres.15535.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/13/2022] Open
Abstract
Tuberculous meningitis (TBM) results from dissemination of M. tuberculosis to the cerebrospinal fluid (CSF) and meninges. Ischaemia, hydrocephalus and raised intracranial pressure frequently result, leading to extensive brain injury and neurodisability. The global burden of TBM is unclear and it is likely that many cases are undiagnosed, with many treated cases unreported. Untreated, TBM is uniformly fatal, and even if treated, mortality and morbidity are high. Young age and human immunodeficiency virus (HIV) infection are potent risk factors for TBM, while Bacillus Calmette-Guérin (BCG) vaccination is protective, particularly in young children. Diagnosis of TBM usually relies on characteristic clinical symptoms and signs, together with consistent neuroimaging and CSF parameters. The ability to confirm the TBM diagnosis via CSF isolation of M. tuberculosis depends on the type of diagnostic tests available. In most cases, the diagnosis remains unconfirmed. GeneXpert MTB/RIF and the next generation Xpert Ultra offer improved sensitivity and rapid turnaround times, and while roll-out has scaled up, availability remains limited. Many locations rely only on acid fast bacilli smear, which is insensitive. Treatment regimens for TBM are based on evidence for pulmonary tuberculosis treatment, with little consideration to CSF penetration or mode of drug action required. The World Health Organization recommends a 12-month treatment course, although data on which to base this duration is lacking. New treatment regimens and drug dosages are under evaluation, with much higher dosages of rifampicin and the inclusion of fluoroquinolones and linezolid identified as promising innovations. The inclusion of corticosteroids at the start of treatment has been demonstrated to reduce mortality in HIV-negative individuals but whether they are universally beneficial is unclear. Other host-directed therapies show promise but evidence for widespread use is lacking. Finally, the management of TBM within health systems is sub-optimal, with drop-offs at every stage in the care cascade.
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Affiliation(s)
- James A Seddon
- Department of Infectious Diseases, Imperial College London, London, W2 1PG, UK
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Lillian Tugume
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Regan Solomons
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Nathan C Bahr
- Department of Infectious Diseases, University of Kansas, Kansas City, KS, USA
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Gashaw F, Bekele S, Mekonnen Y, Medhin G, Ameni G, Erko B. High helminthic co-infection in tuberculosis patients with undernutritional status in northeastern Ethiopia. Infect Dis Poverty 2019; 8:88. [PMID: 31623676 PMCID: PMC6798427 DOI: 10.1186/s40249-019-0600-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/20/2019] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Tuberculosis and parasitosis are the widely distributed diseases in Ethiopia with the leading cause of mortality and morbidity, respectively. There has been no information on the status of co-infections of tuberculosis and parasitosis in Oromia Zone of Amhara Region and South Wollo, Ethiopia. Hence, this study primarily focuses on determining the status of tuberculosis and parasitosis co-infections and associated factors. METHODS The study was conducted in Oromia Special Zone of the Amhara Regional State and South Wollo Zone, northeastern Ethiopia from April 2015 to January 2017. Tuberculosis cases confirmed by health personnel at the health institutions were the source of the study sample. In a cross-sectional study 384 smear positive pulmonary and extra-pulmonary tuberculosis cases were recruited. Faecal specimens provided by the study participants were examined for parasitic co-infections using direct saline microscopic test, Kato-Katz and concentration techniques. Nutritional status was determined using body mass index and mid-upper arm circumferences. Data were analyzed using descriptive statistical methods and Pearson chi-square. RESULTS Tuberculosis and parasitosis co-infection prevalence was 10.8%, and the proportion of intestinal helminths accounted for 9.7% while intestinal protozoa accounted for 1.9%. Cases with single parasitic infection was 89.3% among co-infected individuals. Co-infection of both disease was not significantly associated with gender and age (P > 0.05). The prevalence of undernutrition was 58.6% as determined using body mass index and 73.0% as determined using mid-upper arm circumference with no significant association with gender. Among all forms of tuberculosis cases (384) screened for the study, the bacterial positivity was relatively more common in males (55.5%) than females (44.5%). Tuberculosis lymphadenitis was found to be the most prevalent (85.9%) form of extra-pulmonary tuberculosis with cervical adenopathy (75.3%) being the commonly existing disease. CONCLUSIONS The rate of helminthic co-infection is predominantly high than that of intestinal protozoa. Single parasitic co-infection was more common than double or multiple co-infections. Both body mass index and mid-upper arm circumference anthropometric parameters revealed greater risk of undernutrition in tuberculosis patients. Thus, screening and prompt treatment of parasites in tuberculosis patients and a support of nutritional supplementation for malnourished tuberculosis patients should be further studied which might enhance the disease treatment and minimize the risk of its complexity.
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Affiliation(s)
- Fikru Gashaw
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Microbial, Cellular and Molecular Biology, College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Biology, College of Natural and Computational Sciences, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Samuel Bekele
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yalemtsehay Mekonnen
- Department of Microbial, Cellular and Molecular Biology, College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gobena Ameni
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Berhanu Erko
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, 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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Whittaker E, López-Varela E, Broderick C, Seddon JA. Examining the Complex Relationship Between Tuberculosis and Other Infectious Diseases in Children. Front Pediatr 2019; 7:233. [PMID: 31294001 PMCID: PMC6603259 DOI: 10.3389/fped.2019.00233] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 05/22/2019] [Indexed: 12/21/2022] Open
Abstract
Millions of children are exposed to tuberculosis (TB) each year, many of which become infected with Mycobacterium tuberculosis. Most children can immunologically contain or eradicate the organism without pathology developing. However, in a minority, the organism overcomes the immunological constraints, proliferates and causes TB disease. Each year a million children develop TB disease, with a quarter dying. While it is known that young children and those with immunodeficiencies are at increased risk of progression from TB infection to TB disease, our understanding of risk factors for this transition is limited. The most immunologically disruptive process that can happen during childhood is infection with another pathogen and yet the impact of co-infections on TB risk is poorly investigated. Many diseases have overlapping geographical distributions to TB and affect similar patient populations. It is therefore likely that infection with viruses, bacteria, fungi and protozoa may impact on the risk of developing TB disease following exposure and infection, although disentangling correlation and causation is challenging. As vaccinations also disrupt immunological pathways, these may also impact on TB risk. In this article we describe the pediatric immune response to M. tuberculosis and then review the existing evidence of the impact of co-infection with other pathogens, as well as vaccination, on the host response to M. tuberculosis. We focus on the impact of other organisms on the risk of TB disease in children, in particularly evaluating if co-infections drive host immune responses in an age-dependent way. We finally propose priorities for future research in this field. An improved understanding of the impact of co-infections on TB could assist in TB control strategies, vaccine development (for TB vaccines or vaccines for other organisms), TB treatment approaches and TB diagnostics.
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Affiliation(s)
- Elizabeth Whittaker
- Department of Paediatrics, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St. Mary's Campus, London, United Kingdom
| | - Elisa López-Varela
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Claire Broderick
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - James A. Seddon
- Department of Paediatrics, Imperial College London, London, United Kingdom
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, St. Mary's Campus, London, United Kingdom
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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31
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Donohue RE, Cross ZK, Michael E. The extent, nature, and pathogenic consequences of helminth polyparasitism in humans: A meta-analysis. PLoS Negl Trop Dis 2019; 13:e0007455. [PMID: 31211774 PMCID: PMC6599140 DOI: 10.1371/journal.pntd.0007455] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/28/2019] [Accepted: 05/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background Individual helminth infections are ubiquitous in the tropics; geographical overlaps in endemicity and epidemiological reports suggest areas endemic for multiple helminthiases are also burdened with high prevalences of intestinal protozoan infections, malaria, tuberculosis (TB), and human immunodeficiency virus (HIV). Despite this, pathogens tend to be studied in isolation, and there remains a need for a better understanding of the community ecology and health consequences of helminth polyparasitism to inform the design of effective parasite control programs. Methodology We performed meta-analyses to (i) evaluate the commonality of polyparasitism for helminth-helminth, helminth-intestinal protozoa, helminth-malaria, helminth-TB, and helminth-HIV co-infections, (ii) assess the potential for interspecies interactions among helminth-helminth and helminth-intestinal protozoan infections, and (iii) determine the presence and magnitude of association between specific parasite pairs. Additionally, we conducted a review of reported health consequences of multiply-infected individuals compared to singly- or not multiply-infected individuals. Principal findings We found that helminth-helminth and helminth-intestinal protozoan multiple infections were significantly more common than single infections, while individuals with malaria, TB, and HIV were more likely to be singly-infected with these infections than co-infected with at least one helminth. Most observed species density distributions significantly differed from the expected distributions, suggesting the potential presence of interspecies interactions. All significant associations between parasite pairs were positive in direction, irrespective of the combination of pathogens. Polyparasitized individuals largely exhibited lower hemoglobin levels and higher anemia prevalence, while the differences in growth-related variables were mostly statistically insignificant. Conclusions Our findings confirm that helminth polyparasitism and co-infection with major diseases is common in the tropics. A multitude of factors acting at various hierarchical levels, such as interspecies interactions at the within-host infra-parasite community level and environmental variables at the higher host community level, could explain the observed positive associations between pathogens; there remains a need to develop new frameworks which can consider these multilevel factors to better understand the processes structuring parasite communities to accomplish their control. Helminth infections are a highly prevalent global health problem. These parasitic worm infections occur in areas also burdened with intestinal protozoan infections, malaria, tuberculosis, and human immunodeficiency virus. While these pathogens tend to be studied in isolation, there remains a need to better understand the nature, extent, and health consequences of helminth polyparasitism and co-infection with major diseases. Here, we reviewed the literature and performed meta-analyses to evaluate the commonality of helminth polyparasitism and co-infection, the potential for interspecies interactions between parasites, the association between parasite pairs, and the health consequences among multiply-infected individuals. We confirmed that polyparasitism and co-infection with major diseases are common in the global South and found that multiply-infected individuals experienced worse health consequences when compared to singly or not-multiply infected individuals. Our analysis suggested the potential presence of interspecies interactions and we identified the existence of positive associations between parasite pairs. These findings support the call for integrating deworming into malaria, TB, and HIV treatment protocols and suggest there remains a need to improve our understanding of the factors influencing co-transmission to achieve sustainable parasite control.
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Affiliation(s)
- Rose E. Donohue
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Zoë K. Cross
- University of Utah, Salt Lake City, Utah, United States of America
| | - Edwin Michael
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
- * E-mail:
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32
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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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33
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Impact of Paracoccidioides brasiliensis Coinfection on the Evolution of Schistosoma mansoni-Induced Granulomatous Liver Injury in Mice. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8319465. [PMID: 31019973 PMCID: PMC6451801 DOI: 10.1155/2019/8319465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/11/2019] [Accepted: 03/03/2019] [Indexed: 01/21/2023]
Abstract
The pathogens Schistosoma mansoni and Paracoccidioides brasiliensis share common geographic areas, determining infectious diseases with high mortality rates worldwide. Histopathological and immunological changes induced by each pathogen are well understood; however, the host responses to S. mansoni and P. brasiliensis coinfection are still unknown. Thus, we investigated liver damage and cytokines production in a murine model acutely and chronically coinfected with these pathogens. Fourty male Swiss mice were infected with S. mansoni and P. brasiliensis alone or coinfected. The animals were euthanized with 50 (acute infection) and 120 (chronic infection) days of infection. All infected animals exhibited liver inflammation. Intense granulomatous inflammation was detected in animals infected with S. mansoni alone and those coinfected. Productive and involutive granulomas were clearly observed in acute and chronic infections, respectively. Granuloma size was reduced in the acute phase and increased in the chronic phase of S. mansoni and P. brasiliensis coinfection, compared with animals infected only with S. mansoni. In the chronic phase of infection, the granulomatous inflammation in coinfected animals was characterized by intense neutrophils accumulation and reduced eosinophils number. IFN-γ, IL-2, IL-4, and IL-5 circulating levels were increased in all infected groups. Coinfected animals presented attenuated IFN-γ and IL-4 production in the acute and chronic infections. Taken together, our findings indicate that coinfected animals exhibited a differential modulation of granulomatous inflammation during the acute and chronic phases of infection, which was potentially associated with a divergent profile of cytokines production and migration of neutrophils and eosinophils in response to S. mansoni and P. brasiliensis antigenic stimulation.
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34
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Rowan-Nash AD, Korry BJ, Mylonakis E, Belenky P. Cross-Domain and Viral Interactions in the Microbiome. Microbiol Mol Biol Rev 2019; 83:e00044-18. [PMID: 30626617 PMCID: PMC6383444 DOI: 10.1128/mmbr.00044-18] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The importance of the microbiome to human health is increasingly recognized and has become a major focus of recent research. However, much of the work has focused on a few aspects, particularly the bacterial component of the microbiome, most frequently in the gastrointestinal tract. Yet humans and other animals can be colonized by a wide array of organisms spanning all domains of life, including bacteria and archaea, unicellular eukaryotes such as fungi, multicellular eukaryotes such as helminths, and viruses. As they share the same host niches, they can compete with, synergize with, and antagonize each other, with potential impacts on their host. Here, we discuss these major groups making up the human microbiome, with a focus on how they interact with each other and their multicellular host.
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Affiliation(s)
- Aislinn D Rowan-Nash
- Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island, USA
| | - Benjamin J Korry
- Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island, USA
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Peter Belenky
- Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island, USA
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35
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Tavalire HF, Beechler BR, Buss PE, Gorsich EE, Hoal EG, le Roex N, Spaan JM, Spaan RS, van Helden PD, Ezenwa VO, Jolles AE. Context-dependent costs and benefits of tuberculosis resistance traits in a wild mammalian host. Ecol Evol 2018; 8:12712-12726. [PMID: 30619576 PMCID: PMC6308860 DOI: 10.1002/ece3.4699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/02/2018] [Accepted: 10/12/2018] [Indexed: 12/24/2022] Open
Abstract
Disease acts as a powerful driver of evolution in natural host populations, yet individuals in a population often vary in their susceptibility to infection. Energetic trade-offs between immune and reproductive investment lead to the evolution of distinct life history strategies, driven by the relative fitness costs and benefits of resisting infection. However, examples quantifying the cost of resistance outside of the laboratory are rare. Here, we observe two distinct forms of resistance to bovine tuberculosis (bTB), an important zoonotic pathogen, in a free-ranging African buffalo (Syncerus caffer) population. We characterize these phenotypes as "infection resistance," in which hosts delay or prevent infection, and "proliferation resistance," in which the host limits the spread of lesions caused by the pathogen after infection has occurred. We found weak evidence that infection resistance to bTB may be heritable in this buffalo population (h 2 = 0.10) and comes at the cost of reduced body condition and marginally reduced survival once infected, but also associates with an overall higher reproductive rate. Infection-resistant animals thus appear to follow a "fast" pace-of-life syndrome, in that they reproduce more quickly but die upon infection. In contrast, proliferation resistance had no apparent costs and was associated with measures of positive host health-such as having a higher body condition and reproductive rate. This study quantifies striking phenotypic variation in pathogen resistance and provides evidence for a link between life history variation and a disease resistance trait in a wild mammalian host population.
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Affiliation(s)
- Hannah F. Tavalire
- Department of Integrative BiologyOregon State UniversityCorvallisOregon
- The Institute of Ecology and EvolutionUniversity of OregonEugeneOregon
- Present address:
Prevention Science InstituteUniversity of OregonEugeneOregon
- Present address:
Institute of Ecology and EvolutionUniversity of OregonEugeneOregon
| | | | | | - Erin E. Gorsich
- College of Veterinary MedicineOregon State UniversityCorvallisOregon
- Present address:
Erin E. Gorsich, Zeeman Institute: Systems Biology and Infectious Disease Epidemiology Research (SBIDER)University of WarwickCoventryUK
- Present address:
School of Life SciencesUniversity of WarwickCoventryUK
| | - Eileen G. Hoal
- South African Medical Research Council, DST/NRF Centre of Excellence for Biomedical TB Research, Division of Molecular Biology and Human Genetics, Faculty of Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Nikki le Roex
- South African Medical Research Council, DST/NRF Centre of Excellence for Biomedical TB Research, Division of Molecular Biology and Human Genetics, Faculty of Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Johannie M. Spaan
- Department of Integrative BiologyOregon State UniversityCorvallisOregon
| | - Robert S. Spaan
- Department of Fisheries and WildlifeOregon State UniversityCorvallisOregon
| | - Paul D. van Helden
- South African Medical Research Council, DST/NRF Centre of Excellence for Biomedical TB Research, Division of Molecular Biology and Human Genetics, Faculty of Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Vanessa O. Ezenwa
- Odum School of Ecology and Department of Infectious Diseases, College of Veterinary MedicineUniversity of GeorgiaAthensGeorgia
| | - Anna E. Jolles
- Department of Integrative BiologyOregon State UniversityCorvallisOregon
- College of Veterinary MedicineOregon State UniversityCorvallisOregon
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Miskovic R, Plavsic A, Bolpacic J, Raskovic S, Ranin J, Bogic M. Severe strongyloidiasis and systemic vasculitis: comorbidity, association or both? Case-based review. Rheumatol Int 2018; 38:2315-2321. [PMID: 30353268 DOI: 10.1007/s00296-018-4178-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022]
Abstract
A possible association between strongyloidiasis and systemic vasculitis is rarely reported in the literature. We report the case of a patient with severe strongyloidiasis and an angiographic finding consistent with polyarteritis nodosa. Diagnosis of strongyloidiasis was made by finding of larvae and adult parasites in samples of the upper gastrointestinal tract mucosa and stool. The patient was treated with albendazole, ivermectin and corticosteroid withdrawal. This therapy led to the resolution of symptoms, with repeated stool samples negative for S. stercoralis. However, the clinical course was complicated with pulmonary tuberculosis. Despite tuberculostatic therapy and supportive measures, a lethal outcome occurred. The report is followed by a focused review of the available literature on the association of strongyloidiasis and systemic vasculitis.
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Affiliation(s)
- Rada Miskovic
- Clinic of Allergology and Immunology, Clinical Center of Serbia, Belgrade, Serbia. .,School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Aleksandra Plavsic
- Clinic of Allergology and Immunology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jasna Bolpacic
- Clinic of Allergology and Immunology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanvila Raskovic
- Clinic of Allergology and Immunology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovan Ranin
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic of Infective and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Mirjana Bogic
- Clinic of Allergology and Immunology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
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37
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Brosschot TP, Reynolds LA. The impact of a helminth-modified microbiome on host immunity. Mucosal Immunol 2018; 11:1039-1046. [PMID: 29453411 DOI: 10.1038/s41385-018-0008-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 02/04/2023]
Abstract
Intestinal helminths have well-characterized modulatory effects on mammalian immune pathways. Ongoing helminth infection has been associated with both the suppression of allergies and an altered susceptibility to microbial infections. Enteric helminths share a niche with the intestinal microbiota, and the presence of helminths alters the microbiota composition and the metabolic signature of the host. Recent studies have demonstrated that the helminth-modified intestinal microbiome has the capacity to modify host immune responses even in the absence of live helminth infection. This article discusses the mechanisms by which helminths modify the intestinal microbiome of mammals, and reviews the evidence for a helminth-modified microbiome directly influencing host immunity during infectious and inflammatory diseases. Understanding the multifaceted mechanisms that underpin helminth immunomodulation will pave the way for novel therapies to combat infectious and inflammatory diseases.
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Affiliation(s)
- Tara P Brosschot
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, BC, V8P 5C2, Canada
| | - Lisa A Reynolds
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, BC, V8P 5C2, Canada.
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38
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Barnett LK, Prowse TAA, Peacock DE, Mutze GJ, Sinclair RG, Kovaliski J, Cooke BD, Bradshaw CJA. Previous exposure to myxoma virus reduces survival of European rabbits during outbreaks of rabbit haemorrhagic disease. J Appl Ecol 2018. [DOI: 10.1111/1365-2664.13187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Louise K. Barnett
- Global EcologyCollege of Science and EngineeringFlinders University Adelaide South Australia Australia
| | - Thomas A. A. Prowse
- School of Mathematical SciencesUniversity of Adelaide Adelaide South Australia Australia
| | - David E. Peacock
- Biosecurity South AustraliaDepartment of Primary Industries and Regions Adelaide South Australia Australia
| | - Gregory J. Mutze
- Biosecurity South AustraliaDepartment of Primary Industries and Regions Adelaide South Australia Australia
| | - Ron G. Sinclair
- School of Biological SciencesUniversity of Adelaide Adelaide South Australia Australia
| | - John Kovaliski
- Biosecurity South AustraliaDepartment of Primary Industries and Regions Adelaide South Australia Australia
| | - Brian D. Cooke
- Institute for Applied EcologyUniversity of Canberra Canberra ACT Australia
| | - Corey J. A. Bradshaw
- Global EcologyCollege of Science and EngineeringFlinders University Adelaide South Australia Australia
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39
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DiNardo AR, Nishiguchi T, Mace EM, Rajapakshe K, Mtetwa G, Kay A, Maphalala G, Secor WE, Mejia R, Orange JS, Coarfa C, Bhalla KN, Graviss EA, Mandalakas AM, Makedonas G. Schistosomiasis Induces Persistent DNA Methylation and Tuberculosis-Specific Immune Changes. THE JOURNAL OF IMMUNOLOGY 2018; 201:124-133. [PMID: 29752313 DOI: 10.4049/jimmunol.1800101] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/09/2018] [Indexed: 12/29/2022]
Abstract
Epigenetic mechanisms, such as DNA methylation, determine immune cell phenotype. To understand the epigenetic alterations induced by helminth coinfections, we evaluated the longitudinal effect of ascariasis and schistosomiasis infection on CD4+ T cell DNA methylation and the downstream tuberculosis (TB)-specific and bacillus Calmette-Guérin-induced immune phenotype. All experiments were performed on human primary immune cells from a longitudinal cohort of recently TB-exposed children. Compared with age-matched uninfected controls, children with active Schistosoma haematobium and Ascaris lumbricoides infection had 751 differentially DNA-methylated genes, with 72% hypermethylated. Gene ontology pathway analysis identified inhibition of IFN-γ signaling, cellular proliferation, and the Th1 pathway. Targeted real-time quantitative PCR after methyl-specific endonuclease digestion confirmed DNA hypermethylation of the transcription factors BATF3, ID2, STAT5A, IRF5, PPARg, RUNX2, IRF4, and NFATC1 and cytokines or cytokine receptors IFNGR1, TNFS11, RELT (TNF receptor), IL12RB2, and IL12B (p < 0.001; Sidak-Bonferroni). Functional blockage of the IFN-γ signaling pathway was confirmed, with helminth-infected individuals having decreased upregulation of IFN-γ-inducible genes (Mann-Whitney p < 0.05). Hypomethylation of the IL-4 pathway and DNA hypermethylation of the Th1 pathway was confirmed by Ag-specific multidimensional flow cytometry demonstrating decreased TB-specific IFN-γ and TNF and increased IL-4 production by CD4+ T cells (Wilcoxon signed-rank p < 0.05). In S. haematobium-infected individuals, these DNA methylation and immune phenotypic changes persisted at least 6 mo after successful deworming. This work demonstrates that helminth infection induces DNA methylation and immune perturbations that inhibit TB-specific immune control and that the duration of these changes are helminth specific.
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Affiliation(s)
- Andrew R DiNardo
- The Global Tuberculosis Program, Immigrant and Global Health, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030;
| | - Tomoki Nishiguchi
- The Global Tuberculosis Program, Immigrant and Global Health, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030
| | - Emily M Mace
- Department of Pathology, Baylor College of Medicine, Houston, TX 77030.,Texas Children's Hospital Center for Human Immunobiology, Department of Pediatrics, Texas Children's Hospital Center for Human Immunobiology, Baylor College of Medicine, Houston, TX 77030
| | - Kimal Rajapakshe
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030
| | - Godwin Mtetwa
- Baylor-Swaziland Children's Foundation, Mbabane H100, Swaziland
| | - Alexander Kay
- Baylor-Swaziland Children's Foundation, Mbabane H100, Swaziland
| | | | - W Evan Secor
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA 30333
| | - Rojelio Mejia
- Department of Pediatrics, National School of Tropical Medicine, Texas Children's Hospital Center for Human Immunobiology, Houston, TX 77030
| | - Jordan S Orange
- Department of Pathology, Baylor College of Medicine, Houston, TX 77030.,Texas Children's Hospital Center for Human Immunobiology, Department of Pediatrics, Texas Children's Hospital Center for Human Immunobiology, Baylor College of Medicine, Houston, TX 77030
| | - Cristian Coarfa
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030
| | - Kapil N Bhalla
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX 77030; and
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital Research Institute, Houston, TX 77030
| | - Anna M Mandalakas
- The Global Tuberculosis Program, Immigrant and Global Health, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030
| | - George Makedonas
- Department of Pathology, Baylor College of Medicine, Houston, TX 77030.,Texas Children's Hospital Center for Human Immunobiology, Department of Pediatrics, Texas Children's Hospital Center for Human Immunobiology, Baylor College of Medicine, Houston, TX 77030
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40
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Andreu-Ballester JC, Zamora V, Garcia-Ballesteros C, Benet-Campos C, Lopez-Chuliá F, Tormo-Calandín C, Cuéllar C. Anti-Anisakis sp. antibodies in serum of patients with sepsis and their relationship with γδ T cells and disease severity. Int J Parasitol 2018. [PMID: 29518408 DOI: 10.1016/j.ijpara.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Immunosuppression in sepsis reduces both αβ and γδ T cell subsets. Anisakis sp. is a parasitic nematode with a high prevalence in Spain. Previous contact with the parasite is related to a decrease in γδ T cells. Anti-Anisakis antibodies were measured and related to αβ and γδ T cells in 114 septic patients versus 97 healthy controls. Significant differences were seen with respect to the groups with severe sepsis and septic shock where lower anti-Anisakis levels were observed. A similar decrease appeared in the case of specific IgM with significant differences between the groups of control/uncomplicated sepsis versus severe sepsis and septic shock. These differences were also apparent in the case of specific IgA. The lowest IgE levels were detected in the septic shock group. Anti-Anisakis IgG levels significantly increased in septic shock groups compared with the controls. We observed positive correlations among anti-Anisakis IgA levels and all γδ T cell subsets. There were negative correlations among IgA levels and APACHE and SOFA indices. Greater contact with the parasite (IgG) was directly related with septic shock, inflammation and markers of sepsis severity. A lack of protection in the mucosa (IgA and γδ T cells) was associated with the disease severity.
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Affiliation(s)
| | - Vega Zamora
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad Complutense, 28040 Madrid, Spain
| | | | | | | | | | - Carmen Cuéllar
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad Complutense, 28040 Madrid, Spain.
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41
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Lang R, Schick J. Review: Impact of Helminth Infection on Antimycobacterial Immunity-A Focus on the Macrophage. Front Immunol 2017; 8:1864. [PMID: 29312343 PMCID: PMC5743664 DOI: 10.3389/fimmu.2017.01864] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/08/2017] [Indexed: 12/16/2022] Open
Abstract
Successful immune control of Mycobacterium tuberculosis (MTB) requires robust CD4+ T cell responses, with IFNγs as the key cytokine promoting killing of intracellular mycobacteria by macrophages. By contrast, helminth infections typically direct the immune system toward a type 2 response, characterized by high levels of the cytokines IL-4 and IL-10, which can antagonize IFNγ production and its biological effects. In many countries with high burden of tuberculosis, helminth infections are endemic and have been associated with increased risk to develop tuberculosis or to inhibit vaccination-induced immunity. Mechanistically, regulation of the antimycobacterial immune response by helminths has been mostly been attributed to the T cell compartment. Here, we review the current status of the literature on the impact of helminths on vaccine-induced and natural immunity to MTB with a focus on the alterations enforced on the capacity of macrophages to function as sensors of mycobacteria and effector cells to control their replication.
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Affiliation(s)
- Roland Lang
- Institute of Clinical Microbiology, Immunology and Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Judith Schick
- Institute of Clinical Microbiology, Immunology and Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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42
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Cedeño-Burbano AA, Cerón-Ortega RF, Pacichana-Agudelo CE, Muñoz-García DA, Galeano-Triviño GA, Cardona-Gómez DC, Manquillo-Arias WA, Plaza-Rivera RV. Parasitismo intestinal y tuberculosis. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n4.55864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción.La tuberculosis es coendémica en áreas con alta prevalencia de parasitismo intestinal. Se ha sugerido que, en pacientes con tuberculosis latente, la parasitosis intestinal por helmintos puede desencadenar progresión hacia la forma pulmonar activa, pero esta relación es controversial.Objetivo. Realizar una revisión narrativa de la literatura respecto a la relación existente entre el parasitismo intestinal y la infección por Mycobacterium tuberculosis.Materiales y métodos. Se llevó a cabo una búsqueda de la literatura publicada en las bases de datos ProQuest, EBSCO, ScienceDirect, Pubmed, LILACS, Embase, Trip Database, SciELO y Cochrane Library, con los términos: [Tuberculosis] AND [Intestinal diseases, parasitic] AND [Helminths]; [Tuberculosis] AND [Intestinal diseases, parasitic]; [Tuberculosis] AND [Helminths] en inglés y con sus equivalentes en español. Esta búsqueda se limitó a revisiones sistemáticas con o sin metaanálisis, estudios de cohorte y casos y controles.Resultados. Se encontraron 1 revisión sistemática, 2 estudios de cohorte y 44 estudios de casos y controles con información relevante para el desarrollo de la presente revisión.Conclusiones. La evidencia disponible fue insuficiente para afirmar que el parasitismo intestinal predispone al desarrollo de la enfermedad tuberculosa. Los estudios realizados hasta ahora han encontrado resultados estadísticamente no significativos.
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43
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Cardoso BA, Fonseca FDO, Moraes AHAD, Martins ACGS, Oliveira NVDS, Lima LNGC, Dias GADS, Saad MHF. Environmental aspects related to tuberculosis and intestinal parasites in a low-income community of the Brazilian Amazon. Rev Inst Med Trop Sao Paulo 2017; 59:e57. [PMID: 28793025 PMCID: PMC5553944 DOI: 10.1590/s1678-9946201759057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/17/2017] [Indexed: 11/25/2022] Open
Abstract
We carried out a cross-sectional study from January to December 2015 on 1,425
inhabitants from a floating population in the Brazilian Amazon (Murinin district,
Pará State) to describe the population-based prevalence of
tuberculosis (TB) from 2011 to 2014, recent TB contacts (rCts) latently infected with
Mycobacterium tuberculosis (LTBI) , the coverage
of the local health network, socio-environmental factors, and frequency of intestinal
parasitic infection (IPI). We found that the sanitary structure was inadequate, with
latrines being shared with other rooms within the same accommodation; well water was
the main source of water, and 48% of families had low incomes. The average rate of TB
was 105/100, 000 inhabitants per year; one third of TB patients had been household
contacts of infected individuals in the past, and 23% of rCts were LTBI. More than
half (65%) of 44% of the stools examined (representing 76% of the housing) had IPIs;
the highest prevalence was of fecal-oral transmitted protozoa (40%, Giardia
intestinalis ), followed by soil-transmitted helminths (23%). TB
transmission may be related to insufficient disease control of rCts, frequent
relocation, and underreporting. Education, adopting hygienic habits, improving
sanitation, provision of a treated water supply and efficient sewage system, further
comprehensive epidemiological surveillance of those who enter and leave the community
and resources for basic treatment of IPIs are crucial in combating the transmission
of these neglected diseases.
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Affiliation(s)
- Biatriz Araújo Cardoso
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Microbiologia Celular, Rio de Janeiro, Rio de Janeiro, Brazil.,Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Rio de Janeiro , Rio de Janeiro, Brazil
| | - Fabio de Oliveira Fonseca
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Rio de Janeiro , Rio de Janeiro, Brazil
| | - Antonio Henrique Almeida de Moraes
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Rio de Janeiro , Rio de Janeiro, Brazil
| | | | | | | | | | - Maria Helena Féres Saad
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Microbiologia Celular, Rio de Janeiro, Rio de Janeiro, Brazil
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44
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Reynolds LA, Redpath SA, Yurist-Doutsch S, Gill N, Brown EM, van der Heijden J, Brosschot TP, Han J, Marshall NC, Woodward SE, Valdez Y, Borchers CH, Perona-Wright G, Finlay BB. Enteric Helminths Promote Salmonella Coinfection by Altering the Intestinal Metabolome. J Infect Dis 2017; 215:1245-1254. [PMID: 28368463 DOI: 10.1093/infdis/jix141] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/22/2017] [Indexed: 12/29/2022] Open
Abstract
Intestinal helminth infections occur predominantly in regions where exposure to enteric bacterial pathogens is also common. Helminth infections inhibit host immunity against microbial pathogens, which has largely been attributed to the induction of regulatory or type 2 (Th2) immune responses. Here we demonstrate an additional 3-way interaction in which helminth infection alters the metabolic environment of the host intestine to enhance bacterial pathogenicity. We show that an ongoing helminth infection increased colonization by Salmonella independently of T regulatory or Th2 cells. Instead, helminth infection altered the metabolic profile of the intestine, which directly enhanced bacterial expression of Salmonella pathogenicity island 1 (SPI-1) genes and increased intracellular invasion. These data reveal a novel mechanism by which a helminth-modified metabolome promotes susceptibility to bacterial coinfection.
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Affiliation(s)
- Lisa A Reynolds
- Michael Smith Laboratories, University of British Columbia, Vancouver.,Department of Biochemistry and Microbiology, University of Victoria, British Columbia
| | - Stephen A Redpath
- Department of Microbiology and Immunology, University of British Columbia, Vancouver
| | | | - Navkiran Gill
- Michael Smith Laboratories, University of British Columbia, Vancouver
| | - Eric M Brown
- Michael Smith Laboratories, University of British Columbia, Vancouver.,Department of Microbiology and Immunology, University of British Columbia, Vancouver
| | - Joris van der Heijden
- Michael Smith Laboratories, University of British Columbia, Vancouver.,Department of Microbiology and Immunology, University of British Columbia, Vancouver
| | - Tara P Brosschot
- Michael Smith Laboratories, University of British Columbia, Vancouver
| | - Jun Han
- University of Victoria-Genome British Columbia Proteomics Centre
| | - Natalie C Marshall
- Michael Smith Laboratories, University of British Columbia, Vancouver.,Department of Microbiology and Immunology, University of British Columbia, Vancouver
| | - Sarah E Woodward
- Michael Smith Laboratories, University of British Columbia, Vancouver.,Department of Microbiology and Immunology, University of British Columbia, Vancouver
| | - Yanet Valdez
- Michael Smith Laboratories, University of British Columbia, Vancouver
| | - Christoph H Borchers
- Department of Biochemistry and Microbiology, University of Victoria, British Columbia.,University of Victoria-Genome British Columbia Proteomics Centre.,Gerald Bronfman Department of Oncology and.,Proteomics Centre, Segal Cancer Centre, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Georgia Perona-Wright
- Department of Microbiology and Immunology, University of British Columbia, Vancouver.,Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom ; and
| | - B Brett Finlay
- Michael Smith Laboratories, University of British Columbia, Vancouver.,Department of Microbiology and Immunology, University of British Columbia, Vancouver.,Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, Canada
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45
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Amelio P, Portevin D, Reither K, Mhimbira F, Mpina M, Tumbo A, Nickel B, Marti H, Knopp S, Ding S, Penn-Nicholson A, Darboe F, Ohmiti K, Scriba TJ, Pantaleo G, Daubenberger C, Perreau M. Mixed Th1 and Th2 Mycobacterium tuberculosis-specific CD4 T cell responses in patients with active pulmonary tuberculosis from Tanzania. PLoS Negl Trop Dis 2017; 11:e0005817. [PMID: 28759590 PMCID: PMC5552332 DOI: 10.1371/journal.pntd.0005817] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/10/2017] [Accepted: 07/19/2017] [Indexed: 12/22/2022] Open
Abstract
Mycobacterium tuberculosis (Mtb) and helminth infections elicit antagonistic immune effector functions and are co-endemic in several regions of the world. We therefore hypothesized that helminth infection may influence Mtb-specific T-cell immune responses. We evaluated the cytokine profile of Mtb-specific T cells in 72 individuals with pulmonary TB disease recruited from two Sub-Saharan regions with high and moderate helminth burden i.e. 55 from Tanzania (TZ) and 17 from South Africa (SA), respectively. We showed that Mtb-specific CD4 T-cell functional profile of TB patients from Tanzania are primarily composed of polyfunctional Th1 and Th2 cells, associated with increased expression of Gata-3 and reduced expression of T-bet in memory CD4 T cells. In contrast, the cytokine profile of Mtb-specific CD4 T cells of TB patients from SA was dominated by single IFN-γ and dual IFN-γ/TNF-α and associated with TB-induced systemic inflammation and elevated serum levels of type I IFNs. Of note, the proportion of patients with Mtb-specific CD8 T cells was significantly reduced in Mtb/helminth co-infected patients from TZ. It is likely that the underlying helminth infection and possibly genetic and other unknown environmental factors may have caused the induction of mixed Th1/Th2 Mtb-specific CD4 T cell responses in patients from TZ. Taken together, these results indicate that the generation of Mtb-specific CD4 and CD8 T cell responses may be substantially influenced by environmental factors in vivo. These observations may have major impact in the identification of immune biomarkers of disease status and correlates of protection. Mycobacterium tuberculosis (Mtb) and helminth infections are co-endemic in several regions of the world and their immune responses may be mutually antagonistic. We therefore hypothesized that helminth infection would impact and potentially shape Mtb-specific T-cell responses and systemic inflammation in patients suffering from active pulmonary tuberculosis (TB) enrolled from two helminth endemic regions i.e. Tanzania (TZ) and South Africa (SA). In this study, we demonstrate for the first time that TB patients from SA and TZ harbor distinct immune responses to Mtb antigens. Indeed, we showed that Mtb-specific CD4 T-cell responses of TB patients from TZ were composed by a mixed T helper type 1 (Th1) and Th2 responses. In contrast, the cytokine profile of Mtb-specific CD4 T cells of TB patients from SA was dominated by Th1 cells and associated with TB-induced systemic inflammation and elevated serum levels of type I IFN. Taken together, these data indicate that Mtb-specific T-cell responses are diverse in human populations and can be strongly influenced by host and pathogen genetic background, co-infections and yet unknown environmental factors. Identification of correlates of risk and protection from TB disease will help in the rational development of protective T-cell based vaccines against TB, early monitoring TB treatment outcomes and focused follow up of high risk populations.
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Affiliation(s)
- Patrizia Amelio
- Service of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Damien Portevin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | - Beatrice Nickel
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Hanspeter Marti
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Song Ding
- EuroVacc Foundation, Lausanne, Switzerland
| | - Adam Penn-Nicholson
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Fatoumatta Darboe
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Khalid Ohmiti
- Service of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Thomas J. Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- SVRI, Lausanne, Switzerland
| | - Claudia Daubenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthieu Perreau
- Service of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- * E-mail:
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46
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Watts NS, Mizinduko MM, Barnett ED, White LF, Hochberg NS. Association between parasitic infections and tuberculin skin test results in refugees. Travel Med Infect Dis 2017; 16:35-40. [PMID: 28342825 DOI: 10.1016/j.tmaid.2017.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/17/2017] [Accepted: 03/17/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Parasitic infections are known to modulate the immune response necessary for controlling Mycobacterium tuberculosis infection. We sought to investigate species-specific effects of parasite infection on M. tuberculosis infection. METHODS As part of the Refugee Health Assessment Program, stool examinations and tuberculin skin testing were performed on refugees seen at Boston Medical Center between 1995 and 2012. Tuberculin skin test (TST) and stool examination data were collected for 6669 refugees; 3349 (50.2%) were TST positive (≥10 mm). RESULTS Among TST-positive subjects, 176 (5.3%) had helminth infections and 1149 (34.3%) protozoa. After adjusting for sex, age, and country of origin, helminth and protozoan infections were not associated with TST-positivity. When species-specific effects were examined, subjects infected with Trichuris trichiura and Giardia lamblia had reduced odds of TST-positivity (adjusted OR [aOR] 0.65 [95%CI 0.44-0.96; p = 0.03] and aOR 0.79 [95%CI 0.65-0.95, p = 0.01], respectively). CONCLUSIONS Our findings suggest that T. trichiura and G. lamblia may provide protection against M. tuberculosis infection. This study adds to a growing body of literature suggesting that immune response modulation and susceptibility to M. tuberculosis infection is parasite species-dependent.
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Affiliation(s)
- Nathaniel S Watts
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States.
| | - Mucho M Mizinduko
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States.
| | - Elizabeth D Barnett
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States.
| | - Laura F White
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States.
| | - Natasha S Hochberg
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States; Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States.
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47
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Rodrigues JPF, Caldas IS, Gonçalves RV, Almeida LA, Souza RLM, Novaes RD. S. mansoni-T. cruzi co-infection modulates arginase-1/iNOS expression, liver and heart disease in mice. Nitric Oxide 2017; 66:43-52. [PMID: 28268114 DOI: 10.1016/j.niox.2017.02.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 02/17/2017] [Accepted: 02/27/2017] [Indexed: 12/30/2022]
Abstract
Although Schistosoma species and Trypanosoma cruzi share common endemic areas, co-infections by these parasites remains overlooked. By using a murine model of S. mansoni and T. cruzi co-infection, we investigated if and to what extent these infections might interact to change the pathological outcomes typically observed when the host is infected by a single parasite species. Swiss mice were randomized into four groups: uninfected (NI) and those infected by S. mansoni (SM), T. cruzi (TC) or co-infected (SM + TC). After 120 days of S. mansoni infection, T. cruzi was concurrently inoculated and the infection occurred for 30 days. Taken together, we identified that the overlap of Th2 (schistosomiasis) and Th1 (Chagas disease) immunological patterns changes the host resistance against both pathogens. Beyond impairing the control of granulomatous inflammation, T. cruzi parasitemia and parasitism in co-infected animals, the Th2 inflammatory response against S. mansoni elicits the activation of the arginase-1 pathway to the detriment of inducible oxide nitric synthase (iNOS) expression and nitric oxide (NO) production, contributing to the liver damage, with minor effects on heart pathology.
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Affiliation(s)
| | - Ivo Santana Caldas
- Department of Pathology and Parasitology, Federal University of Alfenas, Alfenas, Minas Gerais, 37130-000, Brazil
| | | | - Leonardo Augusto Almeida
- Department of Microbiology and Immunology, Federal University of Alfenas, Alfenas, Minas Gerais, 37130-000, Brazil
| | - Raquel Lopes Martins Souza
- Department of Pathology and Parasitology, Federal University of Alfenas, Alfenas, Minas Gerais, 37130-000, Brazil
| | - Rômulo Dias Novaes
- Department of Structural Biology, Federal University of Alfenas, Alfenas, Minas Gerais, 37130-000, Brazil.
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48
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The immunoregulatory effects of co-infection with Fasciola hepatica: From bovine tuberculosis to Johne's disease. Vet J 2017; 222:9-16. [PMID: 28410676 DOI: 10.1016/j.tvjl.2017.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 01/16/2023]
Abstract
Fasciola hepatica (liver fluke) is a parasite prevalent in much of the world that causes the economically-important disease of fasciolosis in livestock. The threat that this disease poses extends beyond its direct effects due to the parasite's immunomodulatory effects. Research at this laboratory is focusing on whether this immunoregulation can, in animals infected with liver fluke, exert a bystander effect on concurrent infections in the host. It has already been established that F. hepatica infection reduces cell mediated immune responses to Mycobacterium bovis in cattle, and that the interaction between the two pathogens can be detected on an epidemiological scale. This review explores the immunological consequences of co-infection between F. hepatica and other bacterial infections. Arguments are presented suggesting that immunity of cattle to Mycobacterium avium subsp. paratuberculosis is also likely to be affected.
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49
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Prevalence and clinical relevance of helminth co-infections among tuberculosis patients in urban Tanzania. PLoS Negl Trop Dis 2017; 11:e0005342. [PMID: 28178325 PMCID: PMC5319816 DOI: 10.1371/journal.pntd.0005342] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/21/2017] [Accepted: 01/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Helminth infections can negatively affect the immunologic host control, which may increase the risk of progression from latent Mycobacterium tuberculosis infection to tuberculosis (TB) disease and alter the clinical presentation of TB. We assessed the prevalence and determined the clinical relevance of helminth co-infection among TB patients and household contact controls in urban Tanzania. METHODOLOGY Between November 2013 and October 2015, we enrolled adult (≥18 years) sputum smear-positive TB patients and household contact controls without TB during an ongoing TB cohort study in Dar es Salaam, Tanzania. We used Baermann, FLOTAC, Kato-Katz, point-of-care circulating cathodic antigen, and urine filtration to diagnose helminth infections. Multivariable logistic regression models with and without random effects for households were used to assess for associations between helminth infection and TB. PRINCIPAL FINDINGS A total of 597 TB patients and 375 household contact controls were included. The median age was 33 years and 60.2% (585/972) were men. The prevalence of any helminth infection among TB patients was 31.8% (190/597) and 25.9% (97/375) among controls. Strongyloides stercoralis was the predominant helminth species (16.6%, 161), followed by hookworm (9.0%, 87) and Schistosoma mansoni (5.7%, 55). An infection with any helminth was not associated with TB (adjusted odds ratio (aOR) 1.26, 95% confidence interval (CI): 0.88-1.80, p = 0.22), but S. mansoni infection was (aOR 2.15, 95% CI: 1.03-4.45, p = 0.040). Moreover, S. mansoni infection was associated with lower sputum bacterial load (aOR 2.63, 95% CI: 1.38-5.26, p = 0.004) and tended to have fewer lung cavitations (aOR 0.41, 95% CI: 0.12-1.16, p = 0.088). CONCLUSIONS/SIGNIFICANCE S. mansoni infection was an independent risk factor for active TB and altered the clinical presentation in TB patients. These findings suggest a role for schistosomiasis in modulating the pathogenesis of human TB. Treatment of helminths should be considered in clinical management of TB and TB control programs.
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50
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Alemu G, Mama M. Intestinal helminth co-infection and associated factors among tuberculosis patients in Arba Minch, Ethiopia. BMC Infect Dis 2017; 17:68. [PMID: 28086814 PMCID: PMC5237157 DOI: 10.1186/s12879-017-2195-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/06/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Helminths affect the outcome of tuberculosis by shifting cell mediated immune response to humoral and by total suppression of the host immune system. On the reverse, Mycobacterium infection favors immune escape of helminths. Therefore assessing helminth co-infection rate and predisposing factors in tuberculosis patients is mandatory to set strategies for better case management. METHODS Facility based cross-sectional study was conducted in Arba Minch to assess the prevalence and associated factors of intestinal helminths among pulmonary tuberculosis patients from January to August, 2016. A structured questionnaire was used to capture data about socio-demographic characteristics, clinical history and possible risk factors for intestinal helminth infections. Height and weight were measured to calculate body-mass index. Appropriate amount of stool was collected and processed by direct saline and formol-ether concentration techniques following standard protocols. All the data were analyzed using SPSS version 20.0. RESULTS A total of 213 (57.3% male and 42.7% female) pulmonary tuberculosis patients were participated in the study. The overall co-infection rate of intestinal parasites was 26.3%. The infection rate of intestinal helminths account 24.4% and that of intestinal protozoa was 6.1%. Ascaris lumbricoides accounted the highest frequency of 11.3%. Living in rural residence (AOR = 3.175, 95% CI: 1.102-9.153, p = 0.032), Eating vegetables/ fruits without washing or peeling off (AOR = 2.208, 95% CI: 1.030-4.733, p = 0.042) and having body-mass index <18.5 (AOR = 3.511, 95% CI: 1.646-7.489, p = 0.001) were associated with intestinal helminth infection. CONCLUSION The infection rate by intestinal helminths was 24.4%. Ascaris lumbricoides was the most prevalent helminth. Residence, habit of washing vegetables/fruits before use and body-mass index were associated factors with intestinal helminthiasis. Therefore health care providers should screen and treat TB patients for intestinal helminthiasis in order to ensure good prognosis.
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Affiliation(s)
- Getaneh Alemu
- Department of Medical Laboratory Science, Arba Minch University, Arba Minch, Ethiopia
| | - Mohammedaman Mama
- Department of Medical Laboratory Science, Arba Minch University, Arba Minch, Ethiopia
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