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The Interaction between HIV and Intestinal Helminth Parasites Coinfection with Nutrition among Adults in KwaZulu-Natal, South Africa. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9059523. [PMID: 28421202 PMCID: PMC5380830 DOI: 10.1155/2017/9059523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/23/2017] [Accepted: 02/28/2017] [Indexed: 01/06/2023]
Abstract
In South Africa few studies have examined the effects of the overlap of HIV and helminth infections on nutritional status. This cross-sectional study investigated the interaction between HIV and intestinal helminths coinfection with nutritional status among KwaZulu-Natal adults. Participants were recruited from a comprehensive primary health care clinic and stratified based on their HIV, stool parasitology, IgE, and IgG4 results into four groups: the uninfected, HIV infected, helminth infected, and HIV-helminth coinfected groups. The nutritional status was assessed using body mass index, 24-hour food recall, micro-, and macronutrient biochemical markers. Univariate and multivariate multinomial probit regression models were used to assess nutritional factors associated with singly and dually infected groups using the uninfected group as a reference category. Biochemically, the HIV-helminth coinfected group was associated with a significantly higher total protein, higher percentage of transferrin saturation, and significantly lower ferritin. There was no significant association between single or dual infections with HIV and helminths with micro- and macronutrient deficiency; however general obesity and low micronutrient intake patterns, which may indicate a general predisposition to micronutrient and protein-energy deficiency, were observed and may need further investigations.
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Vlaminck J, Supali T, Geldhof P, Hokke CH, Fischer PU, Weil GJ. Community Rates of IgG4 Antibodies to Ascaris Haemoglobin Reflect Changes in Community Egg Loads Following Mass Drug Administration. PLoS Negl Trop Dis 2016; 10:e0004532. [PMID: 26991326 PMCID: PMC4798312 DOI: 10.1371/journal.pntd.0004532] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/20/2016] [Indexed: 11/19/2022] Open
Abstract
Background Conventional diagnostic methods for human ascariasis are based on the detection of Ascaris lumbricoides eggs in stool samples. However, studies of ascariasis in pigs have shown that the prevalence and the number of eggs detected in the stool do not correlate well with exposure of the herd to the parasite. On the other hand, an ELISA test measuring antibodies to Ascaris suum haemoglobin (AsHb) has been shown to be useful for estimating transmission intensity on pig farms. In this study, we further characterized the AsHb antigen and screened samples from a population-based study conducted in an area that is endemic for Ascaris lumbricoides in Indonesia to assess changes in AsHb antibody rates and levels in humans following mass drug administration (MDA). Methodology/Principal findings We developed and evaluated an ELISA to detect human IgG4 antibodies to AsHb. We tested 1066 plasma samples collected at different times from 599 subjects who lived in a village in rural Indonesia that was highly endemic for ascariasis. The community received 6 rounds of MDA for lymphatic filariasis with albendazole plus diethylcarbamazine between 2002 and 2007. While the AsHb antibody assay was not sensitive for detecting all individuals with Ascaris eggs in their stools, the percentage of seropositive individuals decreased rapidly following MDA. Reductions in antibody rates reflected decreased mean egg output per person both at the community level and in different age groups. Two years after the last round of MDA the community egg output and antibody prevalence rate were reduced by 81.6% and 78.9% respectively compared to baseline levels. Conclusion/Significance IgG4 antibody levels to AsHb appear to reflect recent exposure to Ascaris. The antibody prevalence rate may be a useful indicator for Ascaris transmission intensity in communities that can be used to assess the impact of control measures on the force of transmission. Ascariasis is a neglected tropical disease caused by the intestinal nematode Ascaris lumbricoides that affects hundreds of millions of people in the developing world. Current methods for diagnosis of this infection are based on detecting eggs in the stool that are excreted by adult Ascaris worms. However, these methods have limited sensitivity for recent infections, and they do not detect infections with immature parasite stages that do not always result in the establishment of adult worms in the human intestine. We have previously shown that an assay for antibodies to Ascaris hemoglobin in pig serum is useful for assessing transmission of Ascaris infections on pig farms. In this study, we developed and evaluated a similar antibody assay that is based on the detection of human IgG4 antibodies to Ascaris haemoglobin (AsHb). Community antibody rates decreased rapidly following mass drug administration of the anthelmintic drug albendazole, and this decrease reflected reduced Ascaris egg excretion at the community level. This antibody test may be a useful tool for assessing the impact of control measures on the transmission of new Ascaris infections in endemic populations.
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Affiliation(s)
- Johnny Vlaminck
- Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Taniawati Supali
- Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Peter Geldhof
- Laboratory for Parasitology, Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
| | - Cornelis H. Hokke
- Department of Parasitology, Center for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter U. Fischer
- Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Gary J. Weil
- Infectious Diseases Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
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New Allergens of Relevance in Tropical Regions: The Impact of Ascaris lumbricoides Infections. World Allergy Organ J 2013; 4:77-84. [PMID: 23282442 PMCID: PMC3651106 DOI: 10.1097/wox.0b013e3182167e04] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
One of the many aspects of the relationships between parasite infections and allergic diseases is the possibility that allergens from parasites enhance the TH2 responses, especially IgE production, in allergic diseases such as asthma. In this review we discuss about the allergenic composition of the nematode Ascaris lumbricoides and their potential impact on allergy sensitization and asthma pathogenesis and prevalence in populations living in the tropics and naturally exposed to both, mite allergens and helminth infections.
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Valmonte GR, Cauyan GA, Ramos JDA. IgE cross-reactivity between house dust mite allergens and Ascaris lumbricoides antigens. Asia Pac Allergy 2012; 2:35-44. [PMID: 22348205 PMCID: PMC3269600 DOI: 10.5415/apallergy.2012.2.1.35] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 10/27/2011] [Indexed: 11/27/2022] Open
Abstract
Background Common antigens between intestinal parasites and environmental allergens may play a role in the modulation of allergic immune responses. There is a growing interest in investigating cross-reactivity between common helminths and dust mites affecting humans, particularly in the tropics. Objective This study examined the cross-reactivity between the human roundworm Ascaris lumbricoides (Al) and three house dust mite (HDM) species. Methods Specific serum IgE levels to HDM species Blomia tropicalis (Bt), Dermatophagoides pteronyssinus (Dp), and Dermatophagoides farinae (Df ); and Al extracts among allergic (n=100) and ascariasis (n=60) subjects were measured through enzyme-linked immunosorbent assay (ELISA). IgE-reactive components of HDM and Al extracts were detected through Western-Blot Analysis. Cross-reactivity between HDMs and Al was determined by ELISA inhibition using HDM and Al-specific sera from allergic (n=15) and ascariasis (n=15) subjects. The IgE-binding capacity of a recombinant paramyosin peptide (Blo t 11-fD) to allergic (n=50) and ascariasis (n=50) subjects' sera were likewise determined. Results Among allergic subjects, 70% exhibited Al-specific positive IgE-reactivity, while 20-28% of ascariasis subjects demonstrated HDM-specific positive IgE-reactivity. Multiple IgE-reactive components of HDM allergens (14-240 kDa) and Al antigens (15-250 kDa) were detected, indicating multi-allergen sensitization among the subjects tested. Al antigens can inhibit up to 92% of HDM-specific IgE-reactivity among allergic subjects, while up to 54% of Al-specific IgE-reactivity among ascariasis subjects was inhibited by HDM allergens. Positive rBlo t 11-fD-specific IgE reactivity was observed in 80% of the allergic subjects and 46% of the ascariasis subjects. Conclusions This study showed the presence of multiple cross-reactive antigens in HDM and Al extracts. Identification of these molecules may provide basis for designing novel diagnostic and therapeutic strategies. The potential role of paramyosin as a specific cross-reactive allergen present in HDMs and Al has been shown.
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Affiliation(s)
- Gardette R Valmonte
- Department of Biological Sciences, College of Science, University of Santo Tomas, Manila 1015, Philippines
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Pritchard DI, Blount DG, Schmid-Grendelmeier P, Till SJ. Parasitic worm therapy for allergy: Is this incongruous or avant-garde medicine? Clin Exp Allergy 2011; 42:505-12. [DOI: 10.1111/j.1365-2222.2011.03911.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 09/14/2011] [Accepted: 10/13/2011] [Indexed: 11/28/2022]
Affiliation(s)
- D. I. Pritchard
- Immune Modulation Research Group; School of Pharmacy; University of Nottingham; Nottingham, UK
| | - D. G. Blount
- Immune Modulation Research Group; School of Pharmacy; University of Nottingham; Nottingham, UK
| | | | - S. J. Till
- Department of Asthma; Allergy and Respiratory Science; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; Kings College London; London, UK
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Acevedo N, Caraballo L. IgE cross-reactivity between Ascaris lumbricoides and mite allergens: possible influences on allergic sensitization and asthma. Parasite Immunol 2011; 33:309-21. [PMID: 21388422 DOI: 10.1111/j.1365-3024.2011.01288.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nematode infections such as Ascariasis are important health problems in underdeveloped countries, most of them located in the tropics where environmental conditions also promote the perennial co-exposure to high concentrations of domestic mite allergens. Allergic diseases are common, and most of patients with asthma exhibit a predominant and strong IgE sensitization to mites. It is unknown whether co-exposure to Ascaris lumbricoides and the domestic mites Blomia tropicalis and Dermatophagoides pteronyssinus potentiates Th2 responses and IgE sensitization, thereby modifying the natural history of allergy. Recently, we obtained experimental evidence of a high cross-reactivity between the allergenic extracts of these invertebrates, involving well-known allergens such as tropomyosin and glutathione transferases. There is indirect evidence suggesting that the clinical impact of these findings may be important. In this review, we discuss the potential role of this cross-reactivity on several aspects of allergy in the tropics that have been a focus of a number of investigations, some of them with controversial results.
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Affiliation(s)
- N Acevedo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
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Acevedo N, Sánchez J, Erler A, Mercado D, Briza P, Kennedy M, Fernandez A, Gutierrez M, Chua KY, Cheong N, Jiménez S, Puerta L, Caraballo L. IgE cross-reactivity between Ascaris and domestic mite allergens: the role of tropomyosin and the nematode polyprotein ABA-1. Allergy 2009; 64:1635-43. [PMID: 19624559 DOI: 10.1111/j.1398-9995.2009.02084.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Analysis of cross-reactivity between the nematode Ascaris ssp. and dust mites, two important allergen sources in the tropics, will contribute in understanding their influence on asthma and atopy. The objective of this study was to investigate immunoglobulin E (IgE) cross-reactivity between Ascaris and two domestic mites in the tropics. METHODS Sera from 24 asthmatic patients were used in ELISA and immunoblotting IgE-binding inhibition assays using Ascaris, Blomia tropicalis and Dermatophagoides pteronyssinus extracts and the recombinants Blo t 10, ABA-1 and Blo t 13 as competitors. Identification of Ascaris allergens was confirmed by mass spectrometry (LC-MS/MS). RESULTS We detected at least 12 human IgE-binding components in Ascaris extract. Blomia tropicalis and D. pteronyssinus inhibited 83.3% and 79% of IgE-binding to Ascaris, while Ascaris inhibited 58.3% and 79.3% to B. tropicalis and D. pteronyssinus respectively. Mite tropomyosin inhibited 85% of IgE-binding to Ascaris. Affinity-purified human IgE to rBlo t 10 identified an allergen of 40 kDa in Ascaris extract, further confirmed as tropomyosin by LC-MS/MS. We found no evidence of IgE cross-reactivity between rABA-1 and any allergen component in mite extracts, including rBlo t 13. CONCLUSIONS There is cross-reactivity between Ascaris and mites, determined by several allergens including tropomyosin and glutathione-S-transferase. In addition to its potential impact on asthma pathogenesis, Ascaris infection and mite allergy diagnosis relying on the determination of specific IgE could be affected by this cross-reactivity. ABA-1 has no cross-reactive counterpart in mite extracts, suggesting its usefulness as a more specific marker of Ascaris infection.
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Affiliation(s)
- N Acevedo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
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Flohr C, Tuyen LN, Quinnell RJ, Lewis S, Minh TT, Campbell J, Simmons C, Telford G, Brown A, Hien TT, Farrar J, Williams H, Pritchard DI, Britton J. Reduced helminth burden increases allergen skin sensitization but not clinical allergy: a randomized, double-blind, placebo-controlled trial in Vietnam. Clin Exp Allergy 2009; 40:131-42. [PMID: 19758373 DOI: 10.1111/j.1365-2222.2009.03346.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Observational evidence suggests that infection with helminths protects against allergic disease and allergen skin sensitization. It is postulated that such effects are mediated by helminth-induced cytokine responses, in particular IL-10. OBJECTIVE We tested this hypothesis in a rural area of central Vietnam where hookworm infection is endemic. METHODS One thousand five hundred and sixty-six schoolchildren aged 6-17 were randomly allocated to receive either anti-helminthic therapy or a placebo at 0, 3, 6, and 9 months. We compared changes in the prevalence of exercise-induced bronchoconstriction, allergen skin sensitization, flexural eczema on skin examination, questionnaire-reported allergic disease (wheeze and rhinitis symptoms), and immunological parameters (hookworm-induced IFN-gamma, IL-5, IL-10) between 0 and 12 months. RESULTS One thousand four hundred and eighty-seven children (95% of these randomized) completed the study. The most common helminth infections were hookworm (65%) and Ascaris lumbricoides (7%). There was no effect of the therapy on the primary outcome, exercise-induced bronchoconstriction (within-participant mean percent fall in peak flow from baseline after anti-helminthic treatment 2.25 (SD 7.3) vs. placebo 2.19 (SD 7.8, P=0.9), or on the prevalence of questionnaire-reported wheeze [adjusted odds ratio (OR)=1.16, 95% confidence interval (CI) 0.35-3.82, P=0.8] and rhinitis (adjusted OR=1.39, 0.89-2.15, P=0.1), or flexural dermatitis on skin examination (adjusted OR=1.15, 0.39-3.45, P=0.8). However, anti-helminthic therapy was associated with a significantly higher allergen skin sensitization risk (adjusted OR=1.31, 1.02-1.67, P=0.03). This effect was particularly strong for children infected with A. lumbricoides at baseline (adjusted OR=4.90, 1.48-16.19, P=0.009). Allergen skin sensitization was inversely related to hookworm-specific IL-10 at baseline (adjusted OR=0.76, 0.59-0.99, P=0.04). No cytokine tested, including IL-10, changed significantly after the anti-helminthic therapy compared with the placebo. CONCLUSION A significant reduction in worm burden over a 12-month period in helminth-infected children increases the risk of allergen skin sensitization but not of clinical allergic disease. The effect on skin sensitization could not be fully explained by any of the immunological parameters tested.
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Affiliation(s)
- C Flohr
- Centre for Population Studies, Institute of Clinical Research, University of Nottingham, Nottingham, UK.
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Wright VJ, Ame SM, Haji HS, Weir RE, Goodman D, Pritchard DI, Ramsan Mohamed M, Haji HJ, Tielsch JM, Stoltzfus RJ, Bickle QD. Early exposure of infants to GI nematodes induces Th2 dominant immune responses which are unaffected by periodic anthelminthic treatment. PLoS Negl Trop Dis 2009; 3:e433. [PMID: 19436745 PMCID: PMC2677666 DOI: 10.1371/journal.pntd.0000433] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 04/14/2009] [Indexed: 12/04/2022] Open
Abstract
We have previously shown a reduction in anaemia and wasting malnutrition in infants <3 years old in Pemba Island, Zanzibar, following repeated anthelminthic treatment for the endemic gastrointestinal (GI) nematodes Ascaris lumbricoides, hookworm and Trichuris trichiura. In view of the low intensity of worm infections in this age group, this was unexpected, and it was proposed that immune responses to the worms rather than their direct effects may play a significant role in morbidity in infants and that anthelminthic treatment may alleviate such effects. Therefore, the primary aims of this study were to characterise the immune response to initial/early GI nematode infections in infants and the effects of anthelminthic treatment on such immune responses. The frequency and levels of Th1/Th2 cytokines (IL-5, IL-13, IFN-γ and IL-10) induced by the worms were evaluated in 666 infants aged 6–24 months using the Whole Blood Assay. Ascaris and hookworm antigens induced predominantly Th2 cytokine responses, and levels of IL-5 and IL-13 were significantly correlated. The frequencies and levels of responses were higher for both Ascaris positive and hookworm positive infants compared with worm negative individuals, but very few infants made Trichuris-specific cytokine responses. Infants treated every 3 months with mebendazole showed a significantly lower prevalence of infection compared with placebo-treated controls at one year following baseline. At follow-up, cytokine responses to Ascaris and hookworm antigens, which remained Th2 biased, were increased compared with baseline but were not significantly affected by treatment. However, blood eosinophil levels, which were elevated in worm-infected children, were significantly lower in treated children. Thus the effect of deworming in this age group on anaemia and wasting malnutrition, which were replicated in this study, could not be explained by modification of cytokine responses but may be related to eosinophil function. Infants and very young children commonly become infected with intestinal nematode infections. However, the worm burdens are generally very light, so a beneficial effect of deworming on wasting malnutrition and anaemia in this age group which we have demonstrated was unexpected and the mechanism unclear. To investigate this, we have, for the first time, determined whether such worm infections in infants induce significant immune reactions which might be detrimental to nutrition and growth e.g. by inducing inflammation in the gut or by cytokine effects on erythropoiesis. We also determined if such responses are modulated by regular deworming over a 9 month period. Peripheral blood cells from infants infected with Ascaris and hookworms in particular responded to stimulation with worm antigens, producing predominantly Th2 cytokines. Although the Th2 cytokine responses in the periphery were not significantly altered by deworming, the levels of eosinophils, which are regulated by the Th2 cytokine, IL-5, were lower after treatment. It is possible that eosinophils play a role in gut pathology leading to wasting malnutrition and anaemia in the very young and that this effect is reduced by deworming.
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Affiliation(s)
- Victoria J. Wright
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shaali Makame Ame
- Public Health Laboratory Ivo de Carneri, Wawi, Chake Chake, Pemba Island, Zanzibar, United Republic of Tanzania
| | - Haji Said Haji
- Public Health Laboratory Ivo de Carneri, Wawi, Chake Chake, Pemba Island, Zanzibar, United Republic of Tanzania
| | - Rosemary E. Weir
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Goodman
- Centre for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David I. Pritchard
- School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
| | | | - Hamad Juma Haji
- Public Health Laboratory Ivo de Carneri, Wawi, Chake Chake, Pemba Island, Zanzibar, United Republic of Tanzania
| | - James M. Tielsch
- Centre for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Rebecca J. Stoltzfus
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Quentin D. Bickle
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Leonardi-Bee J, Pritchard D, Britton J. Asthma and current intestinal parasite infection: systematic review and meta-analysis. Am J Respir Crit Care Med 2006; 174:514-23. [PMID: 16778161 DOI: 10.1164/rccm.200603-331oc] [Citation(s) in RCA: 220] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Epidemiologic studies suggest that intestinal parasite infections may protect against asthma. OBJECTIVES A systematic review and meta-analysis of epidemiologic studies to determine whether total or species-specific current parasite infection is associated with a reduced risk of asthma or wheeze. METHODS We searched MEDLINE, EMBASE, and CINAHL (up to January 2006); reviews; and reference lists from publications, with no language restrictions. We included studies that reported asthma or wheeze as an outcome measure and ascertained parasite infection by fecal examination. We estimated pooled odds ratios (OR) and 95% confidence intervals (CI) using data extracted from published papers, or where available, original data provided by authors, using random effect models. MEASUREMENTS AND MAIN RESULTS Thirty-three studies met the inclusion criteria. Infection with any parasite was associated with a small, nonsignificant increase in asthma risk (OR, 1.24; 95% CI, 0.98-1.57; 29 studies). In species-specific analysis, Ascaris lumbricoides was associated with significantly increased odds of asthma (OR, 1.34; 95% CI, 1.05-1.71; 20 studies), while hookworm infection was associated with a significantly strong reduction (OR, 0.50; 95% CI, 0.28-0.90; 9 studies) that was directly and significantly related to infection intensity (p < 0.001; OR for highest tertile of infection, 0.34; 95% CI, 0.19-0.62). Other species had no significant effects on asthma. Infection effects on wheeze were derived from smaller numbers, but revealed a broadly similar pattern of results. CONCLUSIONS Parasite infections do not in general protect against asthma, but infection with hookworm may reduce the risk of this disease.
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Affiliation(s)
- Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham NG5 1PB, UK.
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Fleming FM, Brooker S, Geiger SM, Caldas IR, Correa-Oliveira R, Hotez PJ, Bethony JM. Synergistic associations between hookworm and other helminth species in a rural community in Brazil. Trop Med Int Health 2006; 11:56-64. [PMID: 16398756 DOI: 10.1111/j.1365-3156.2005.01541.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify possible synergistic associations of hookworm and other helminths. METHOD Cross-sectional survey of all households within 10 km2 of Americaninhas, a rural community in Minas Gerais, Brazil. We determined the prevalence and intensity of single and multiple helminth species infection in an age-stratified sample of 1332 individuals from 335 households. RESULTS Hookworm was the most prevalent helminth infection (68.2%), followed by Ascaris lumbricoides (48.8%) and Schistosoma mansoni (45.3%). Overall, 60.6% of individuals harboured mixed helminth infections. Multivariate analysis indicated significant positive associations for co-infection with hookworm and S. mansoni and for co-infection with hookworm and A. lumbricoides. Co-infections with hookworm and A. lumbricoides resulted in higher egg counts for both, suggesting a synergistic relationship between these species, although, we found important age differences in this relationship. However, the intensity of S. mansoni or A. lumbricoides co-infection did not differ from that of mono-infection. CONCLUSION These results have implications for the epidemiology, immunology and control of multiple helminth infections. More research is needed to examine the rates of re-infection and immune responses after chemotherapy, and to what extent the effects of polyparasitism are altered by chemotherapy.
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Affiliation(s)
- Fiona M Fleming
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
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Abstract
Advances in hookworm immunoepidemiology are reviewed. Recent studies demonstrate a mixed Th1/Th2 response in human hookworm infection, with immunosuppression of specific and nonspecific IFN-gamma responses. There is increasing evidence for protective immunity in human hookworm infection, including anti-larval IL-5- and IgE-dependent mechanisms, and for immunological interactions between hookworm infection and other diseases.
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Affiliation(s)
- R J Quinnell
- School of Biology, University of Leeds, Leeds LS2 9JT, UK.
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Corrêa-Oliveira R, Golgher DB, Oliveira GC, Carvalho OS, Massara CL, Caldas IR, Colley DG, Gazzinelli G. Infection with Schistosoma mansoni correlates with altered immune responses to Ascaris lumbricoides and hookworm. Acta Trop 2002; 83:123-32. [PMID: 12088853 DOI: 10.1016/s0001-706x(02)00108-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies were performed on humoral and cellular immune responses of patients from areas in Brazil endemic for hookworm and Ascaris lumbricoides, and either endemic or non-endemic for Schistosoma mansoni. Humoral and cellular responses were evaluated by enzyme-linked immunosorbant assay (ELISA) and peripheral blood mononuclear cell (PBMC) proliferation assays against larval hookworm antigens, A. lumbricoides egg antigens, and soluble egg antigens (SEA) or soluble whole adult antigenic preparation (SWAP) from S. mansoni. Patients from S. mansoni-endemic areas, who currently had only hookworm or Ascaris infections, expressed lower humoral and cellular responses to hookworm or Ascaris antigens, respectively, than did their counterparts from areas not endemic for S. mansoni. Individuals from S. mansoni endemic area, although without detectable S. mansoni infection, do mount humoral and cellular responses to SEA and SWAP. This group of individuals has been probably in contact with S. mansoni antigens, since the groups harboring A. lumbricoides or hookworm infections from non-S. mansoni endemic areas do not have detectable anti-S. mansoni responses. PBMC proliferative responses discriminated well between patients with active hookworm infections versus ascariasis, if they were from areas not endemic for S. mansoni.
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Affiliation(s)
- Rodrigo Corrêa-Oliveira
- Lab. de Immunologia Celular e Molecular, Centro de Pesquisas René Rachou-FIOCRUZ, Av. Augusto de Lima 1715 Barro Preto, Belo Horizonte, MG, 30190-002, Brazil.
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Abstract
Two hookworm parasites, Necator americanus and Ancylostoma duodenale, infect approximately one billion people worldwide. These hookworms are one of the leading causes of iron-deficiency anaemia especially in children, resulting directly from intestinal capillary blood loss following the feeding activities of fourth-stage (L(4)) larva and adult worms. If ignored, human hookworm infections can retard growth and the intellectual development of children. Another clinical manifestation often associated with hookworm infections is cutaneous larva migrans (CLM). It is a well recognised, usually self-limiting condition caused by the infectious larvae of nematodes, especially Ancylostoma spp. CLM is characterised by skin eruption and represents a clinical description rather than a definitive diagnosis. Of the hookworm parasites, the dog and cat worm A. braziliense and A. caninum are the most common nematodes causing CLM, although many other species have also been implicated. The major subject of this review article will be discussion of the evolution of therapies and treatment of human necatoriasis and the development of experimental infections with N. americanus. Difference in the clinical efficacy of mebendazole and albendazole will be discussed along with drug resistance of N. americanus.
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Affiliation(s)
- V S Georgiev
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, 7600-B Rockledge Drive, Room 2102, Bethesda, Maryland 20892, USA.
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15
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Booth M, Mayombana C, Kilima P. The population biology and epidemiology of schistosome and geohelminth infections among schoolchildren in Tanzania. Trans R Soc Trop Med Hyg 1998; 92:491-5. [PMID: 9861359 DOI: 10.1016/s0035-9203(98)90886-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
A study of helminth infections was undertaken among 3244 schoolchildren from 28 schools in Morogoro Rural District, Tanzania. Schistosoma haematobium was the most common infection, followed by hookworms, Ascaris lumbricoides, S. mansoni, and Trichuris trichiura. Infection prevalence of each species varied among schools and age groups, but not between sexes. There was no relationship between the prevalences of different infections among schools, except for a strong negative correlation between the prevalence of hookworm and S. mansoni infections. Within each age group, there was little excess overlap in the distribution of each infection; thus the number of multiple infections was low whereas the number of individuals harbouring at least one infection was relatively high. More children than expected carried infections of A. lumbricoides and S. mansoni, and the clustering effect increased with age. Only 2 schools had high overall infection prevalences of both geohelminths and schistosomes. Logistic regression analysis of morbidity and parasitological data indicated that individuals with multiple species infections were not at increased risk of morbidity (on a multiplicative scale) compared to individuals with single species infections. This was attributed in part to the low egg counts observed for each parasite species. The results implied little interaction between schistosome and geohelminth infections in the region, both in parasitological terms and in the context of their combined effects on health. Implications for the feasibility and benefits of combined control of geohelminths and schistosomes are discussed.
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Affiliation(s)
- M Booth
- Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland.
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16
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Needham CS, Lillywhite JE, Beasley NM, Didier JM, Kihamia CM, Bundy DA. Potential for diagnosis of intestinal nematode infections through antibody detection in saliva. Trans R Soc Trop Med Hyg 1996; 90:526-30. [PMID: 8944263 DOI: 10.1016/s0035-9203(96)90306-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The present study was the first to investigate the potential of saliva in community diagnosis of the major human intestinal nematode infections, Trichuris trichiura, Ascaris lumbricoides, and the hookworms. Immunoglobulin G (IgG) antibodies specific to parasite antigens were quantified in saliva samples of 187 individuals (all ages) from a St Lucian community, and 120 school-aged children from Tanga region, Tanzania, and relationships with current infection status (determined by numbers of parasite eggs in stool) were examined. For T. trichiura infection, the age relationships of parasite-specific salivary IgG antibodies mirrored those of infection intensity at the community level. Within both areas, children with current T. trichiura infection exhibited significantly higher anti-T. trichiura salivary IgG responses than uninfected children. Similar trends were apparent for A. lumbricoides and hookworm infections, though not to a level of statistical significance. Comparison of mean T. trichiura infection levels and antibody responses in age-matched children from St Lucia and Tanzania suggested that measurement of parasite-specific salivary IgG may have potential as a marker of transmission intensity at the community level.
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Affiliation(s)
- C S Needham
- Department of Zoology, University of Oxford, UK
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17
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Abstract
Human IgE responses to helminth infections have been described as both problematic and beneficial, in that type 1 hypersensitivity to parasite infections can reputedly cause pathology and/or parasite expulsion, (Pritchard, Quinnell & Walsh 1995). In the present communication, we can report that the IgE response to helminth infections may be beneficial in a diagnostic sense, in that antibodies of this isotype showed minimal cross-reactivity against antigens from the parasites tested. This information may be of benefit to workers attempting to establish ELISA assays for the specific diagnosis of zoonotic hookworm infections, for example, Ancylostoma caninum (Croese 1988), particularly in regions where human hookworm infection is endemic.
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Affiliation(s)
- D I Pritchard
- Department of Life Science, University of Nottingham, UK
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19
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Dennis RD, Baumeister S, Smuda C, Lochnit C, Waider T, Geyer E. Initiation of chemical studies on the immunoreactive glycolipids of adult Ascaris suum. Parasitology 1995; 110 ( Pt 5):611-23. [PMID: 7596644 DOI: 10.1017/s0031182000065331] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
There is a general lack of basic information concerning one class of glycoconjugate, the glycolipids, from parasitic nematodes. As the prototype, the neutral glycolipid fraction derived from adult males of Ascaris suum was investigated as to its chromatographic, differential chemical staining, antigenic and chemical properties. The thin-layer chromatography-resolved neutral fraction glycolipids could be classified into components of fast and slow migrating band groups. Immunoreactivity was restricted to the latter as detected by IgG and IgM anti-neutral fraction glycolipid antibody levels in serial infection sera of mice. Similarities of chromatography, antigenicity and serological cross-reactivity have been extended to the neutral glycolipid fractions of other parasitic nematodes: Litomosoides carinii and Nippostrongylus brasiliensis. Chemical, differential chemical staining and enzymatic analyses identified the Ascaris suum antigenic, slow migrating band group of components as amphoteric glycosphingolipids, and not the originally hypothesized glycoglycerolipids or glycosylphosphatidylinositols, that contained typical neutral monosaccharide constituents and a zwitterionic phosphodiester linkage, most probably phosphocholine. Glycosphingolipid-immunoreactivity is eliminated on cleavage of the zwitterionic phosphodiester linkage by hydrofluoric acid treatment.
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Affiliation(s)
- R D Dennis
- Allgemeine und Medizinische Parasitologie, FB Biologie, Philipps-Universität Marburg, Germany
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20
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Shiddo SA, Huldt G, Nilsson LÅ, Ouchterlony Ö, Thorstensson R. High concentrations of serum IgG can cause pitfalls in antiglobulin tests. ACTA ACUST UNITED AC 1994. [DOI: 10.1016/0888-0786(94)90020-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Abstract
The introduction in 1971, by Engvoll and Perlmann, of enzyme labels in immunoassays represented a significant technical advance. Their enzyme-linked immunosorbent assay (ELISA) proved to be as sensitive as radioimmunoossoys but safer to use. Since then, ELISAs have been widely used in the assay o f anti-bodies and antigens. In this article, Pradhib Venkateson and Derek Wokelin focus on some o f the problems associated with ELISAs when applied to parasitic infections, which can modify antibody responses, by immunosuppression or polyclonal activation. The article also considers optimization, which is an essential step in the establishment o f on ELISA.
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Affiliation(s)
- P Venkatesan
- Department of Life Science, University of Nottingham, Nottingham, UK NG7 2RD
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22
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Pritchard DI, Walsh EA, Quinell RJ, Raiko A, Edmonds P, Keymer AE. Isotypic variation in antibody responses in a community in Papua New Guinea to larval and adult antigens during infection, and following reinfection, with the hookworm Necator americanus. Parasite Immunol 1992; 14:617-31. [PMID: 1470481 DOI: 10.1111/j.1365-3024.1992.tb00034.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The natural infection of a community with the hookworm Necator americanus induces a vigorous humoral response to both larval and adult parasite antigens. This response occurs in all five human antibody isotypes, and data are presented to show that, at the population level, isotypes respond differently, following chemotherapy and during reinfection, to changes in antigen stimulation. The differential response probably reflects the fact that the parasite, during the course of its life cycle, presents different amounts of antigens at different anatomical locations. It is suggested that IgG and IgM responses against adult excretory-secretory (ES) products most accurately reflect the efficacy of chemotherapy, and the load of resident adult infection, while IgG responses against larval somatic antigens reflect continuous exposure to infection. These hypotheses should now be tested, at the level of the individual, in a longitudinal manner using more closely spaced sampling intervals. This repetitive sampling, and the inclusion of a measure of the exposure of the population to infective stages, will allow more definitive conclusions to be made about the role of the immune response in controlling worm burdens.
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Affiliation(s)
- D I Pritchard
- Department of Life Science, University of Nottingham
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