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Tesfaye S, zerfu B, Desta K. Magnitude and associated factors of Intestinal Parasitosis and Tuberculosis among Tuberculosis suspected patients attending Kuyu General Hospital, North Shewa, Oromia, Ethiopia. PLoS Negl Trop Dis 2022; 16:e0010120. [PMID: 35007304 PMCID: PMC8782461 DOI: 10.1371/journal.pntd.0010120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/21/2022] [Accepted: 12/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intestinal parasites and Tuberculosis (TB) co-infection is a major public health problem. The parasitic infection suppresses the cell mediated immunity that protects tuberculosis. Helminthes-induced immune modulation promotes progression to active tuberculosis. However, there is paucity of evidences on the intestinal parasites-tuberculosis co-infection in Ethiopia. This study explores the magnitude and associated factors of intestinal parasitic infection and TB among suspected pulmonary Tuberculosis (PTB) patients. METHODOLOGY A cross-sectional study design was conducted in Kuyu General Hospital from December 2019-March 2020. The socio-demographic data and associated factors were collected by structured questionnaire and then spot-spot sputum and fresh stool samples were collected following standard guidelines and were processed. Descriptive analysis was conducted and reported in frequency and percentage. Bivariate analysis was computed and a multivariable analysis was conducted to provide an adjusted odds ratio (AOR). P-value <0.05 at 95% confidence interval was considered as statistically significant. RESULTS The burden of intestinal parasites was 20.2% (49/ 242) and 6.1% (20/ 242) of them were helminths infections and 14.1% (29/ 242) were protozoa infections. Of 242 patients, 14.9% (36/242) were sputum smear-positive for acid fast-bacilli. Of 36 smear positive patients, 9(25%) had TB-intestinal parasites co-infection. Dwelling in rural areas and having untrimmed fingernails were statistically significantly associated with intestinal parasites. Having a contact history of Tb patients was significantly associated with pulmonary tuberculosis. CONCLUSIONS The magnitude of intestinal parasites and TB among PTB suspected patients were high. Hookworm infection was the predominant helmenthic infection. It is important to consider screening TB patients for intestinal parasites and treat co-infection properly.
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Affiliation(s)
- Sahilu Tesfaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Biruk zerfu
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kassu Desta
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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2
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Wong WK, Mohd-Nor N, Noordin R, Foo PC, Mohamed Z, Haq JA, Acosta A, Sarmiento ME, Subramaniam P, Dony JF, Mohamad-Roze MN, Osman S, Lim BH. Parasitic infections in Malaysian aborigines with pulmonary tuberculosis: a comparative cross-sectional study. Parasitol Res 2019; 118:2635-2642. [PMID: 31363922 DOI: 10.1007/s00436-019-06406-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/19/2019] [Indexed: 12/13/2022]
Abstract
The geographical distribution of tuberculosis (TB) overlaps with various parasitic infections. Uncovering the characteristics of coinfecting parasites that potentially affect the host susceptibility to TB is pertinent as it may provide input to current TB therapeutic and prophylactic measures. The present study was aimed at examining the types of parasitic infections in TB patients and healthy TB contacts (HC) in Orang Asli, Malaysian aborigines, who dwelled in the co-endemic areas. Stool and serum samples were collected from Orang Asli who fulfilled the selection criteria and provided written informed consents. Selected parasitic infections in the two study groups were determined by stool examination and commercial serum antibody immunoassays. The prevalence of parasitic infections in TB and HC participants were 100% (n = 82) and 94.6% (n = 55) respectively. The parasitic infections comprised toxocariasis, trichuriasis, amoebiasis, toxoplasmosis, hookworm infection, ascariasis, strongyloidiasis, and brugian filariasis, in decreasing order of prevalence. Overall, helminth or protozoa infection did not show any significant association with the study groups. However, when the species of the parasite was considered, individuals exposed to trichuriasis and toxoplasmosis showed significant odds reduction (odds ratio (OR) 0.338; 95% confidence interval (CI) 0.166, 0.688) and odds increment (OR 2.193; 95% CI 1.051, 4.576) to have active pulmonary TB, respectively. In conclusion, trichuriasis and toxoplasmosis may have distinct negative and positive associations respectively with the increase of host susceptibility to TB.
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Affiliation(s)
- Weng-Kin Wong
- School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Norazmi Mohd-Nor
- School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Rahmah Noordin
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, George Town, Malaysia
| | - Phiaw-Chong Foo
- School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.,Acarology Unit, Infectious Disease Research Centre, Ministry of Health, Institute for Medical Research, Putrajaya, Malaysia
| | - Zeehaida Mohamed
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | | | - Armando Acosta
- School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Maria E Sarmiento
- School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Puvaneswari Subramaniam
- Tuberculosis and Leprosy Control Unit, Ministry of Health, Perak State Health Department, Ipoh, Malaysia
| | - Jiloris F Dony
- Tuberculosis & Leprosy Sector, Ministry of Health, Putrajaya, Malaysia
| | | | - Sabariah Osman
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, George Town, Malaysia
| | - Boon-Huat Lim
- School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia. .,Institute for Research in Molecular Medicine, Universiti Sains Malaysia, George Town, Malaysia.
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3
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Datta S, Sherman JM, Tovar MA, Bravard MA, Valencia T, Montoya R, Quino W, D'Arcy N, Ramos ES, Gilman RH, Evans CA. Sputum Microscopy With Fluorescein Diacetate Predicts Tuberculosis Infectiousness. J Infect Dis 2017; 216:514-524. [PMID: 28510693 PMCID: PMC5853787 DOI: 10.1093/infdis/jix229] [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: 12/26/2016] [Accepted: 05/11/2017] [Indexed: 01/03/2023] Open
Abstract
Background Sputum from patients with tuberculosis contains subpopulations of metabolically active and inactive Mycobacterium tuberculosis with unknown implications for infectiousness. Methods We assessed sputum microscopy with fluorescein diacetate (FDA, evaluating M. tuberculosis metabolic activity) for predicting infectiousness. Mycobacterium tuberculosis was quantified in pretreatment sputum of patients with pulmonary tuberculosis using FDA microscopy, culture, and acid-fast microscopy. These 35 patients’ 209 household contacts were followed with prevalence surveys for tuberculosis disease for 6 years. Results FDA microscopy was positive for a median of 119 (interquartile range [IQR], 47–386) bacteria/µL sputum, which was 5.1% (IQR, 2.4%–11%) the concentration of acid-fast microscopy–positive bacteria (2069 [IQR, 1358–3734] bacteria/μL). Tuberculosis was diagnosed during follow-up in 6.4% (13/209) of contacts. For patients with lower than median concentration of FDA microscopy–positive M. tuberculosis, 10% of their contacts developed tuberculosis. This was significantly more than 2.7% of the contacts of patients with higher than median FDA microscopy results (crude hazard ratio [HR], 3.8; P = .03). This association maintained statistical significance after adjusting for disease severity, chemoprophylaxis, drug resistance, and social determinants (adjusted HR, 3.9; P = .02). Conclusions Mycobacterium tuberculosis that was FDA microscopy negative was paradoxically associated with greater infectiousness. FDA microscopy–negative bacteria in these pretreatment samples may be a nonstaining, slowly metabolizing phenotype better adapted to airborne transmission.
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Affiliation(s)
- Sumona Datta
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Infectious Diseases and Immunity and Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Jonathan M Sherman
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marco A Tovar
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Marjory A Bravard
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Teresa Valencia
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosario Montoya
- Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Willi Quino
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Nikki D'Arcy
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
| | - Eric S Ramos
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Carlton A Evans
- Innovation for Health and Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru.,Infectious Diseases and Immunity and Wellcome Trust Centre for Global Health Research, Imperial College London, United Kingdom.,Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
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4
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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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5
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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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6
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It May Be Too Early to Try to Prove the Effect of Deworming on Tuberculin Reactivity. Pediatr Infect Dis J 2017; 36:241. [PMID: 28079837 DOI: 10.1097/inf.0000000000001401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Re: "It May Be Too Early to Try to Prove the Effect of Deworming on Tuberculin Reactivity". Pediatr Infect Dis J 2017; 36:241-242. [PMID: 28079838 DOI: 10.1097/inf.0000000000001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Helminth-Tuberculosis Co-infection: An Immunologic Perspective. Trends Immunol 2016; 37:597-607. [PMID: 27501916 DOI: 10.1016/j.it.2016.07.005] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 01/15/2023]
Abstract
Over 2 billion people worldwide are infected with helminths (worms). Similarly, infection with Mycobacterium tuberculosis (Mtb) occurs in over a third of the world's population, often with a great degree of geographical overlap with helminth infection. Interestingly, the responses induced by the extracellular helminths and those induced by the intracellular Mtb are often mutually antagonistic and, as a consequence, can result in impaired (or cross-regulated) host responses to either of the infecting pathogens. In this review, we outline the nature of the immune responses induced by infections with helminths and tuberculosis (TB) and then provide data from both experimental models and human studies that illustrate how the immune response engendered by helminth parasites modulates Mtb-specific responses in helminth-TB coinfection.
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9
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Marques M, Ruffino-Netto A, Marques AMC, Andrade SMOD, Silva BAKD, Pontes ERJC. [Pulmonary tuberculosis among residents of municipalities in Mato Grosso do Sul State, Brazil, bordering on Paraguay and Bolivia]. CAD SAUDE PUBLICA 2016; 30:2631-42. [PMID: 26247992 DOI: 10.1590/0102-311x00191513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 07/10/2014] [Indexed: 11/22/2022] Open
Abstract
This study analyzed the epidemiological profile of pulmonary tuberculosis from 2007 to 2010 in municipalities (counties) in Mato Grosso do Sul State, Brazil, that border on Paraguay and Bolivia. In the border region, the incidence rate (49.1/100,000 inhabitants), mortality rate (4.0/100,000 inhabitants), and treatment dropout rate (11.3%) were 1.6, 1.8, and 1.5 times higher than in the non-border region. Among indigenous individuals in the border region, the rates for incidence (253.4/100,000 inhabitants), mortality (11.6/100,000 inhabitants), and HIV/TB co-infection (1.9/100,000 inhabitants) were 6.4, 3.2, and 1.9 times higher than in non-indigenous individuals in this region. Living in the border regions was inversely associated with HIV/TB co-infection. Indigenous ethnicity was associated statistically with not abandoning TB treatment. The study concludes that the population residing in these municipalities along the border is exposed to high risk of pulmonary TB and TB mortality and treatment dropout, thus requiring special health surveillance interventions.
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Affiliation(s)
- Marli Marques
- Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
| | - Antonio Ruffino-Netto
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
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Bates M, Marais BJ, Zumla A. Tuberculosis Comorbidity with Communicable and Noncommunicable Diseases. Cold Spring Harb Perspect Med 2015; 5:cshperspect.a017889. [PMID: 25659380 DOI: 10.1101/cshperspect.a017889] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The 18th WHO Global Tuberculosis Annual Report indicates that there were an estimated 8.6 million incident cases of tuberculosis (TB) in 2012, which included 2.9 million women and 530,000 children. TB caused 1.3 million deaths including 320,000 human immunodeficiency virus (HIV)-infected people; three-quarters of deaths occurred in Africa and Southeast Asia. With one-third of the world's population latently infected with Mycobacterium tuberculosis (Mtb), active TB disease is primarily associated with a break down in immune surveillance. This explains the strong link between active TB disease and other communicable diseases (CDs) or noncommunicable diseases (NCDs) that exert a toll on the immune system. Comorbid NCD risk factors include diabetes, smoking, malnutrition, and chronic lung disease, all of which have increased relentlessly over the past decade in developing countries. The huge overlap between killer infections such as TB, HIV, malaria, and severe viral infections with NCDs, results in a "double burden of disease" in developing countries. The current focus on vertical disease programs fails to recognize comorbidities or to encourage joint management approaches. This review highlights major disease overlaps and discusses the rationale for better integration of tuberculosis care with services for NCDs and other infectious diseases to enhance the overall efficiency of the public health responses.
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Affiliation(s)
- Matthew Bates
- University of Zambia-University College London Medical School (UNZA-UCLMS) Research and Training Project, University Teaching Hospital, Lusaka RW1X, Zambia Center for Clinical Microbiology, Department of Infection, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Ben J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI) and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Alimuddin Zumla
- National Institute of Health Research, Biomedical Research Centre, Royal Free Campus Rowland Hill St, University College London Hospitals, London NW3 2PF, United Kingdom
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11
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du Plessis N, Walzl G. Helminth-M. tb co-infection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 828:49-74. [PMID: 25253027 DOI: 10.1007/978-1-4939-1489-0_3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nelita du Plessis
- Biomedical Sciences, Division Molecular Biology and Human Genetics, DST/NRF, Centre of Excellence in Biomedical TB Research, Stellenbosch University, Cape Town, Western Cape, South Africa,
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12
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Littleton J, Park J, Nelesone T. HELMINTHS AND TB IN POLYNESIA: THE IMPLICATIONS FOR HEALTH PRACTICE. ANNALS OF ANTHROPOLOGICAL PRACTICE 2013. [DOI: 10.1111/napa.12004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Piñeiro-Pérez R, García-Hortelano M, José Mellado M, García-Ascaso M, Medina-Claros A, Fernández N, Subirats M, José Cilleruelo M. Is there interference in the interpretation of the tuberculin skin test in children with intestinal parasitic infestation? Pathog Glob Health 2013; 106:172-6. [PMID: 23265375 DOI: 10.1179/2047773212y.0000000023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Infestation by intestinal parasites could be a cause of a false-negative tuberculin skin test (TST) result. OBJECTIVE To evaluate TST results in a population of immigrants and internationally adopted children and to analyze whether intestinal parasitic infestation may modify or not TST results. METHODS A cross-sectional observational study which includes adopted children or immigrants evaluated in our hospital between January 2003 and December 2008. The TST was considered as the dependent variable and independent variables were gender, age, geographical origin, bacille Calmette-Guérin scar, nutritional status, immune status, and intestinal parasitism. RESULTS One thousand and seventy-four children were included, of whom 69·6% were female. There was a bacillus Calmette-Guérin scar in 79% of the children and in 20·3% intestinal parasites were found. There were no differences in TST results among infested and non-infested children. CONCLUSIONS Intestinal parasitic infestation did not change TST results in our study and these results coincide with recent articles regarding questionable interference that intestinal parasitic infestations may produce on TST results.
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Affiliation(s)
- Roi Piñeiro-Pérez
- Pediatrics Infectious and Tropical Diseases Unit, Department of Pediatrics, Hospital Universitario Puerta de Hierro — Majadahonda, Majadahonda, Madrid, Spain.
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14
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Wiria AE, Djuardi Y, Supali T, Sartono E, Yazdanbakhsh M. Helminth infection in populations undergoing epidemiological transition: a friend or foe? Semin Immunopathol 2012; 34:889-901. [PMID: 23129304 DOI: 10.1007/s00281-012-0358-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/21/2012] [Indexed: 12/21/2022]
Abstract
Helminth infections are highly prevalent in developing countries, especially in rural areas. With gradual development, there is a transition from living conditions that are dominated by infection, poor sanitation, manual labor, and traditional diet to a situation where burden of infections is reduced, infrastructure is improved, sedentary lifestyle dominates, and processed food forms a large proportion of the calorie intake. The combinations of some of the changes in lifestyle and environment are expected to result in alteration of the landscape of diseases, which will become dominated by non-communicable disorders. Here we review how the major helminth infections affect a large proportion of the population in the developing world and discuss their impact on the immune system and the consequences of this for other infections which are co-endemic in the same areas. Furthermore, we address the issue of decreasing helminth infections in many parts of the world within the context of increasing inflammatory, metabolic, and cardiovascular diseases.
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Lopez M, White AC, Cabada MM. Burden of Fasciola hepatica Infection among children from Paucartambo in Cusco, Peru. Am J Trop Med Hyg 2012; 86:481-5. [PMID: 22403322 DOI: 10.4269/ajtmh.2012.11-0448] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
There is a high prevalence of fascioliasis in the Peruvian highlands, but most cases remain undiagnosed. The burden of disease caused by chronic subclinical infection is largely unknown. We studied school-age children from a district in Paucartambo Province in Cusco, Peru to evaluate the burden of disease caused by subclinical fascioliasis. Parasite eggs and/or larvae were identified in 46.2% of subjects, including Fasciola hepatica in 10.3% of subjects. Fascioliasis was independently associated with anemia (adjusted odds ratio = 3.01 [1.10-8.23]). Subclinical fascioliasis was common among children and strongly associated with anemia. Anemia should be recognized as an important component of the burden of disease from fascioliasis.
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Legesse M, Ameni G, Mamo G, Medhin G, Bjune G, Abebe F. Association of the level of IFN-γ produced by T cells in response to Mycobacterium tuberculosis-specific antigens with the size of skin test indurations among individuals with latent tuberculosis in a highly tuberculosis-endemic setting. Int Immunol 2012; 24:71-8. [PMID: 22298884 DOI: 10.1093/intimm/dxr102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
There is growing evidence showing the potential of T-cell-based gamma interferon (IFN-γ) release assays (IGRAs) for predicting the risk of progression of Mycobacterium tuberculosis (Mtb) infection, though there is little information from tuberculosis (TB)-endemic settings. In this study, we assessed the association between the level of IFN-γ produced by T cells in response to Mtb-specific antigens and the size of skin test indurations in 505 adult individuals who were screened for latent tuberculosis infection (LTBI) using the QuantiFERON-TB Gold In Tube (QFTGIT) assay and tuberculin skin test (TST). There was a strong positive correlation between the level of IFN-γ induced by the specific antigens and the diameter of the skin indurations (Spearman's rho = 0.6, P < 0.001). Body mass index and parasitic infection were not associated with the level of IFN-γ production or the TST reaction. In linear regression analysis, the size of the skin test indurations was significantly associated with the mean level of IFN-γ [coefficient, 0.65; 95% confidence interval (CI), 0.47 to 0.82, P < 0.001]. Similarly, results from logistic regression analysis demonstrated that individuals who had skin test indurations ≥ 10 mm were 6.82 times more likely than individuals who had skin test indurations < 10 mm to have high levels of IFN-γ (i.e. positive QFTGIT result) (adjusted odd ratio = 6.82; 95% CI, 3.67 to 12.69, P < 0.001). In conclusion, the results of this study could provide indirect evidence for the prognostic use of the QFTGIT assay for progression of Mtb infection, though prospective follow-up studies are needed to provide direct evidence.
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Affiliation(s)
- Mengistu Legesse
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
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Kolbaum J, Tartz S, Hartmann W, Helm S, Nagel A, Heussler V, Sebo P, Fleischer B, Jacobs T, Breloer M. Nematode-induced interference with the anti-Plasmodium CD8+ T-cell response can be overcome by optimizing antigen administration. Eur J Immunol 2012; 42:890-900. [PMID: 22161305 DOI: 10.1002/eji.201141955] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 11/16/2011] [Accepted: 12/02/2011] [Indexed: 12/29/2022]
Abstract
Malaria is still responsible for up to 1 million deaths per year worldwide, highlighting the need for protective malaria vaccines. Helminth infections that are prevalent in malaria endemic areas can modulate immune responses of the host. Here we show that Strongy-Ioides ratti, a gut-dwelling nematode that causes transient infections, did not change the efficacy of vaccination against Plasmodium berghei. An ongoing infection with Litomosoides sigmodontis, a tissue-dwelling filaria that induces chronic infections in BALB/c mice, significantly interfered with vaccination efficacy. The induction of P. berghei circumspor-ozoite protein (CSP)-specific CD8(+) T cells, achieved by a single immunization with a CSP fusion protein, was diminished in L. sigmodontis-infected mice. This modulation was reflected by reduced frequencies of CSP-specific CD8(+) T cells, reduced CSP-specific IFN-y and TNF-a production, reduced CSP-specific cytotoxicity, and reduced protection against P. berghei challenge infection. Implementation of a more potent vaccine regime, by first priming with CSP-expressing recombinant live Salmonella prior to CSP fusion protein immunization, restored induction of CSP-specific CD8(+) T cells and conferred almost sterile immunity to P. berghei challenge infection also in L. sigmodontis-infected mice. In summary, we show that appropriate vaccination regimes can overcome helminth-induced interference with vaccination efficacy.
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Affiliation(s)
- Julia Kolbaum
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Sundberg MA, Costa D, Orge G, Castro NM, Muniz A, Glesby MJ, Carvalho EM. Helminthic infection and the risk of neurologic disease progression in HTLV-1. J Clin Virol 2012; 53:251-5. [PMID: 22237002 DOI: 10.1016/j.jcv.2011.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 11/11/2011] [Accepted: 12/15/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infection with the human T-cell lymphotropic virus, type 1 (HTLV-1) has been associated with an increased Th1 response. Interestingly, a higher prevalence of helminthic coinfection has been observed among infected individuals, and subsequent modulation of the immune response typically associated with helminths may influence clinical outcomes among HTLV-1 coinfected individuals. OBJECTIVE This study was conducted to elucidate the association between helminthic coinfection and the development of clinically characterized neurologic disease that occurs in HTLV-1 infection. STUDY DESIGN In a cohort analysis, incidence of HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP) was recorded. Incidence of clinical outcomes and disease-free survival of several neurologic outcomes associated with HTLV-1 were estimated using the Kaplan-Meier method with log-rank tests. The relationships between helminthic infection and risk of HTLV-1 neurologic outcomes were assessed by Cox proportional hazard modeling. RESULTS Seventy-four coinfected and 79 non-coinfected patients were followed, with 92 helminthic infections observed in the coinfected group. One patient per group developed HAM/TSP and the risk of progression to neurologic disease outcomes did not differ among those with and without helminthic coinfection (p>0.45). A significant difference was noted in the prevalence of neurologic disease outcomes among all patients at the conclusion of the study (p<0.01). CONCLUSIONS These data suggest that treated helminthic infection does not affect risk of development of neurologic disease in HTLV-1 infection, and reinforce that treatment of helminths does not adversely affect patients with HTLV-1. Importantly, among all patients, an overall progression of neurologic disease was observed.
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Affiliation(s)
- Michael A Sundberg
- Stanford University School of Medicine, Medical School Office Building Room 323, Stanford, CA 94305-5404, USA.
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