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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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Feyisa JW, Berhanu RD, Lema M, Desalegn M, Merdassa E, Kitila KM, Hailu WB, Beyena SD, Shama AT. Magnitude and determinants of undernutrition among tuberculosis patients in Ethiopia: systematic review and meta-analysis. BMC Public Health 2024; 24:1698. [PMID: 38918733 PMCID: PMC11201327 DOI: 10.1186/s12889-024-19220-3] [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: 05/02/2023] [Accepted: 06/21/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Undernutrition increases the risk of TB infection to be active TB, death and relapse of the disease. Undernutrition also disturbs the management process of tuberculosis. Therefore, this study aimed to estimate the pooled magnitude and determinants of undernutrition among TB patients in Ethiopia. METHODS From August 20, 2022 to January 6, 2023, the research articles were identified via the search engines Google Scholar, Medline, Pub Med, Cochrane Library, and Web of Science. Stata version 14 was used for analysis, along with a standardized data extraction checklist. The Cochrane Q test statistic and I2 statistics were used to determine heterogeneity. A random-effect model was used to assess the extent of undernutrition among TB patients. OR with a 95% CI was used to report the relationship between undernutrition and independent factors. A funnel plot and Egger's test were used to examine publication bias. RESULTS A total of 720 research articles were identified via several databases and 21 studies were included in the systematic review and meta-analysis. The pooled magnitude of undernutrition among TB patients was 48.23% (95% CI 42.84, 53.62). The current meta-analysis revealed that patients who had no formal education (OR = 2.11(95%CI: 1.09, 4.06), average monthly income < 1800 ETB (OR = 2.32 (95CI: 1.33, 4.04), unable to work (OR = 2.61(95CI:1.99, 3.43), patients who had eating disorder (OR = 2.73 (95CI: 2.09, 3.56), patients who had intestinal parasite (OR = 3.77 (95CI: 2.39, 5.94), patients of > 5 family size (OR = 3.79 (95CI: 1.06, 14.93), and patients who drank alcohol (OR = 1.47(95CI: 1.06, 2.05) were significantly associated with undernutrition. CONCLUSION This meta-analysis examined the high magnitude of undernutrition among TB patients in Ethiopia. Strategic and police-oriented intervention to prevent factors contributing to the problem is mandatory.
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Affiliation(s)
- Jira Wakoya Feyisa
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia.
| | - Robera Demissie Berhanu
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Matiyos Lema
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
| | - Markos Desalegn
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
| | - Emiru Merdassa
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
| | - Keno Melkamu Kitila
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Wase Benti Hailu
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
| | - Sidie Debelo Beyena
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
| | - Adisu Tafari Shama
- Department of Public Health, Institute of Health Sciences, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
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Oni O, Orok E, Lawal Z, Ojo T, Oluwadare T, Bamitale T, Jaiyesimi B, Akinjisola A, Apara T. Knowledge and perception of nosocomial infections among patients in a Nigerian hospital. Sci Rep 2023; 13:20204. [PMID: 37980389 PMCID: PMC10657427 DOI: 10.1038/s41598-023-47661-0] [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: 07/12/2023] [Accepted: 11/16/2023] [Indexed: 11/20/2023] Open
Abstract
Nosocomial infections are infections that are a leading cause of morbidity and mortality among hospitalized patients, and can lead to higher healthcare costs and longer hospital stays in both developed and developing countries. The objectives of the study were to identify the level of knowledge and perception of patients on nosocomial infection, and to determine the factors affecting the knowledge and perception of patients on nosocomial infection in Federal Medical Centre, Ebute-Metta, Lagos (FMC). A cross-sectional research design was used in carrying out the research among in-patients of FMC where an interview-based semi-structured questionnaire was used for data collection. Patients' knowledge was categorised as good (≥ 70% score), fair (50-69%) and poor (< 50% score) while perception was grouped as positive and negative. Independent sample T-test and One-way Analysis of Variance was used to assess statistical difference in knowledge scores between categorical variables with 2 and 3 groups respectively. A total of 102 patients gave consent to participate in this study of which 46.1% were male, 27.5% were aged between 38 and 47 years and 69.6% were married. About 24% did not know what is meant by nosocomial infections while 53.9% stated that all hospital-acquired infections are preventable. Less than 19% strongly disagreed that making alcohol rubs mandatory for all visitors would decrease the incidence of nosocomial infections while all strongly agreed that if left untreated, such infections can become life-threatening. Overall, 15.7% showed good knowledge while most patients showed fair knowledge (71.6%) and a negative perception (51%) of nosocomial infections. There was a significant difference in patients' knowledge of nosocomial infections based on age (0.012). There was also a statistically significant association between age and perception of patients towards nosocomial infections (p = 0.031). This study showed that most patients had fair knowledge as well as negative perception towards nosocomial infections. Age, had an influence on patients' perception and knowledge of nosocomial infection.
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Affiliation(s)
- Olawale Oni
- Department of Public Health, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Edidiong Orok
- Department of Clinical Pharmacy and Public Health, College of Pharmacy, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria.
| | - Zainab Lawal
- Department of Public Health, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Tolulope Ojo
- Department of Public Health, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Tunrayo Oluwadare
- Department of Public Health, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Toba Bamitale
- Department of Mathematical and Physical Sciences, College of Science, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Boluwaji Jaiyesimi
- Department of Mathematical and Physical Sciences, College of Science, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Alice Akinjisola
- Department of Public Health, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Titilayo Apara
- Department of Public Health, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
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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: 0] [Impact Index Per Article: 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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Semahegn A, Manyazewal T, Getachew E, Fekadu B, Assefa E, Kassa M, Davey G, Hopkins M, Araya M, Woldehanna T, Hanlon C, Fekadu A. Burden of neglected tropical diseases and access to medicine and diagnostics in Ethiopia: a scoping review. Syst Rev 2023; 12:140. [PMID: 37580784 PMCID: PMC10424375 DOI: 10.1186/s13643-023-02302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND More than 1.7 billion people are affected by neglected tropical diseases (NTDs) worldwide. Forty percent of the NTD-affected people live in Africa with the poorest, most vulnerable, and hard to reach geographical areas. The NTDs cause significant social and economic burden and deepen marginalization and stigmatization. The World Health Organization's current roadmap for NTD aims to prevent, control, eliminate, or eradicate 20 tropical diseases. Ethiopia experiences a high burden of these diseases, but current access to diagnostics, medicine, and/or care has been little explored to inform the country's NTD strategic plan. The overall purpose of the scoping review was to map and characterize the burden of NTDs and challenges in access to diagnostics, medicine, and/or care in Ethiopia. METHODS A systematic search of evidence was conducted in PubMed, Cochrane Library, and Google Scholar from January 2000 until May 2022, without restrictions of language or study design. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was followed for screening of studies. Key findings were extracted and narrated qualitatively. RESULTS The search resulted in 4532 articles, of which 105 met the inclusion criteria and were included in the scoping review under three themes: burden of NTDs, access to diagnostics, medicine and/or care, and key barriers. Although gains have been made in the prevention and control of NTDs in Ethiopia, the burden remains high, and progress in access to diagnostics, medicine/drugs, and/or care is very slow. Poverty, poor quality of life, and underfunding of NTD programs decelerate the process of NTD elimination program in the country. CONCLUSIONS The scoping review identified a considerable number of studies on the burden of NTDs in Ethiopia and strategies for diagnosis, treatment, and/or care; however, there is a paucity of evidence on the suitability and potential benefits of novel diagnostic technologies and medicines in the country. A regular review and analysis of such country-level evidence is important to inform the country NTDs roadmap and local implementation strategies.
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Affiliation(s)
- Agumasie Semahegn
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
- Department of Population, Family and Reproductive Health, School of Public Health, Unversity of Ghana, Accra, Ghana.
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyerusalem Getachew
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethelhem Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Economics, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Munir Kassa
- Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Gail Davey
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Michael Hopkins
- Science Policy Research Unit, University of Sussex, Brighton, UK
| | - Mesele Araya
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
- Policy Studies Institute, Addis Ababa, Ethiopia
| | - Tassew Woldehanna
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Lebu S, Kibone W, Muoghalu CC, Ochaya S, Salzberg A, Bongomin F, Manga M. Soil-transmitted helminths: A critical review of the impact of co-infections and implications for control and elimination. PLoS Negl Trop Dis 2023; 17:e0011496. [PMID: 37561673 PMCID: PMC10414660 DOI: 10.1371/journal.pntd.0011496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Researchers have raised the possibility that soil-transmitted helminth (STH) infections might modify the host's immune response against other systemic infections. STH infections can alter the immune response towards type 2 immunity that could then affect the likelihood and severity of other illnesses. However, the importance of co-infections is not completely understood, and the impact and direction of their effects vary considerably by infection. This review synthesizes evidence regarding the relevance of STH co-infections, the potential mechanisms that explain their effects, and how they might affect control and elimination efforts. According to the literature reviewed, there are both positive and negative effects associated with STH infections on other diseases such as malaria, human immunodeficiency virus (HIV), tuberculosis, gestational anemia, pediatric anemia, neglected tropical diseases (NTDs) like lymphatic filariasis, onchocerciasis, schistosomiasis, and trachoma, as well as Coronavirus Disease 2019 (COVID-19) and human papillomavirus (HPV). Studies typically describe how STHs can affect the immune system and promote increased susceptibility, survival, and persistence of the infection in the host by causing a TH2-dominated immune response. The co-infection of STH with other diseases has important implications for the development of treatment and control strategies. Eliminating parasites from a human host can be more challenging because the TH2-dominated immune response induced by STH infection can suppress the TH1 immune response required to control other infections, resulting in an increased pathogen load and more severe disease. Preventive chemotherapy and treatment are currently the most common approaches used for the control of STH infections, but these approaches alone may not be adequate to achieve elimination goals. Based on the conclusions drawn from this review, integrated approaches that combine drug administration with water, sanitation and hygiene (WASH) interventions, hygiene education, community engagement, and vaccines are most likely to succeed in interrupting the transmission of STH co-infections. Gaining a better understanding of the behavior and relevance of STH co-infections in the context of elimination efforts is an important intermediate step toward reducing the associated burden of disease.
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Affiliation(s)
- Sarah Lebu
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Winnie Kibone
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Chimdi C. Muoghalu
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen Ochaya
- Department of Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Department of Biology, Faculty of Science, Gulu University, Gulu, Uganda
- Department of Clinical Pathology, Uppsala Academic Hospital, Uppsala, Sweden
| | - Aaron Salzberg
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Felix Bongomin
- Department of Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Musa Manga
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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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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Differential effects of asymptomatic Ascaris lumbricoides, Schistosoma mansoni or hook worm infection on the frequency and TGF-beta-producing capacity of regulatory T cells during active tuberculosis. Tuberculosis (Edinb) 2021; 131:102126. [PMID: 34601265 DOI: 10.1016/j.tube.2021.102126] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023]
Abstract
Helminth induced expansion of regulatory T cells (Tregs) may take part in suppressing protective host responses during tuberculosis (TB), although Tregs functionality and link to TB disease severity remains unexplored. We investigated the species-specific effect of helminths on frequency and TGF-β producing capacity of Tregs, and possible connection to TB disease severity. 89 pulmonary TB patients (PTB) and 69 community controls (CCs) from Gondar, Ethiopia, were included. Clinical disease severity was graded by TB score, and flow cytometry used to characterize Treg frequency and functionality measured as their TGF-β-producing capacity. In helminth positive PTB patients (Helminth+PTB+) compared to helminth negative PTB or CCs, TGF-β+ Tregs were significantly increased mainly in hookworm coinfection whereas S. mansoni increased TGF-β+ Tregs in CCs. Treatment of TB and helminths decreased TGF-β+ Tregs in Helminth+PTB+ at 2 months follow-up. There were no overall differences in the frequency of Tregs in CCs or PTB unless stratification on TB disease severity was performed. At inclusion Helminth+PTB+ had increased frequency of Tregs already at low disease severity, and TGF-β+ Tregs correlated to intermediate-to-high disease severity. In conclusion, helminth specific increase of TGF-β+ Tregs in PTB patients was correlated to TB disease severity and was restored following anti-helminth treatment.
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