Hookworm-provoked IgE-mediated Pathology: Capricious Damage or Remarkable Strategy?

Prevalence of Endoparasites in Urban Stray Dogs from Brazil Diagnosed with Leishmania, with Potential for Human Zoonoses

BACKGROUND

In tropical environments, abandoned animals can be an important source for human zoonotic infections, such as human visceral leishmaniasis and other vector-borne diseases. Here, we report the frequency of protozoan and helminth intestinal parasites in stray dogs, which might have an implication for human health in urban Brazilian settings.

MATERIAL AND METHODS

We performed necropsies on 93 animals, euthanized due to canine visceral leishmaniasis control program, and examined their intestines looking for the presence of helminths; we determined the parasite load, and the elimination of eggs and cysts of protozoan parasites in fecal samples. Further, we performed serology tests for the detection of specific antibodies against Toxoplasma gondii.

RESULTS

Overall, a high prevalence of intestinal parasites with potential for human zoonoses resulted and only 8.6% of examined intestines remained negative. The most prevalent helminths were Ancylostoma caninum and Dipylidium caninum. For nematodes, high worm burdens were detected for A. caninum and Trichuris vulpis. Additionally, we analyzed worm burdens and quantitative stool examinations, but found no significant association between positive serology for Leishmania infection and intestinal parasite burden. Interestingly, serology for T. gondii infection revealed a prevalence of 33.3% and a positive result was significantly associated with a higher A. caninum adult worm recovery (p = 0.0087).

CONCLUSION

Our results showed stray dogs living in urban areas are heavily parasitized, which presents a potential risk for humans. Beyond the control of canine visceral leishmaniasis, we propose an improvement of the control program to reduce the risk for other parasitic diseases in dogs and humans.

Mucosal immune responses following intestinal nematode infection

In most natural environments, the large majority of mammals harbour parasitic helminths that often live as adults within the intestine for prolonged periods (1–2 years) 1. Although these organisms have been eradicated to a large extent within westernized human populations, those living within rural areas of developing countries continue to suffer from high infection rates. Indeed, recent estimates indicate that approximately 2·5 billion people worldwide, mainly children, currently suffer from infection with intestinal helminths (also known as geohelminths and soil-transmitted helminths) 2. Paradoxically, the eradication of helminths is thought to contribute to the increased incidence of autoimmune diseases and allergy observed in developed countries. In this review, we will summarize our current understanding of host–helminth interactions at the mucosal surface that result in parasite expulsion or permit the establishment of chronic infections with luminal dwelling adult worms. We will also provide insight into the adaptive immune mechanisms that provide immune protection against re-infection with helminth larvae, a process that is likely to be key to the future development of successful vaccination strategies. Lastly, the contribution of helminths to immune modulation and particularly to the treatment of allergy and inflammatory bowel disease will be discussed.

Intestinal allergy expels hookworms: seeing is believing

It is unclear how immunity limits hookworm infection. Australian researchers, using capsule and conventional gastrointestinal endoscopy in volunteers inoculated with Necator americanus, have reported that virtually all larvae reach the intestine within six weeks. Unlike the neutral response surrounding resident hookworms, newly arrived adults provoke an eosinophilic enteropathy. This allergic reaction curtails the attachment of hookworms and accompanies the passage of additional worms as they are expelled from the proximal small intestine.

Allergy controls the population density of Necator americanus in the small intestine

BACKGROUND & AIMS

Nearly 700 million people remain infected with hookworms. Although allergy is intuitively linked to immunity against helminths, few positive examples have been characterized. Larval migration through the lungs has been considered the likely interface at which hookworm attrition occurs. As part of a study evaluating a potential role for hookworms in the modulation of human autoimmunity, we examined parasite migration and intestinal colonization.

METHODS

Capsule and conventional endoscopies supplemented the evaluation of healthy volunteers and Crohn's disease patients recently inoculated with larvae of the human hookworm Necator americanus. Two healthy volunteers with a previously established and stable hookworm infection were inoculated with 50 larvae and had serial capsule endoscopies performed.

RESULTS

Eosinophilic enteritis developed in all subjects after the initial inoculation. Newly inoculated larvae in the 2 subjects with an established infection reliably reached the intestine within 4 weeks. Thereafter, the colony diminished to the host's constitutive status quo because mostly immature worms failed to attach. The intensity of the eosinophilic response correlated negatively with the time available for hookworms to feed and positively with hookworm attrition.

CONCLUSIONS

Necator larval migration to the intestine is uncontested. We propose that allergic inflammation purposefully degrades the hookworm's bite, causing premature detachment, restricted feeding, and expulsion. This novel biological dynamic suggests a new paradigm of hookworm resistance.

Immune responses in hookworm infections

Hookworms infect perhaps one-fifth of the entire human population, yet little is known about their interaction with our immune system. The two major species are Necator americanus, which is adapted to tropical conditions, and Ancylostoma duodenale, which predominates in more temperate zones. While having many common features, they also differ in several key aspects of their biology. Host immune responses are triggered by larval invasion of the skin, larval migration through the circulation and lungs, and worm establishment in the intestine, where adult worms feed on blood and mucosa while injecting various molecules that facilitate feeding and modulate host protective responses. Despite repeated exposure, protective immunity does not seem to develop in humans, so that infections occur in all age groups (depending on exposure patterns) and tend to be prolonged. Responses to both larval and adult worms have a characteristic T-helper type 2 profile, with activated mast cells in the gut mucosa, elevated levels of circulating immunoglobulin E, and eosinophilia in the peripheral blood and local tissues, features also characteristic of type I hypersensitivity reactions. The longevity of adult hookworms is determined probably more by parasite genetics than by host immunity. However, many of the proteins released by the parasites seem to have immunomodulatory activity, presumably for self-protection. Advances in molecular biotechnology enable the identification and characterization of increasing numbers of these parasite molecules and should enhance our detailed understanding of the protective and pathogenetic mechanisms in hookworm infections.