The relationship between Trichuris trichiura transmission intensity and the age-profiles of parasite-specific antibody isotypes in two endemic communities

Serological diagnosis of soil-transmitted helminth (Ascaris, Trichuris and hookworm) infections: A scoping review

BACKGROUND

The World Health Organization emphasizes the importance of integrated monitoring and evaluation in neglected tropical disease (NTD) control programs. Serological assays offer a potential solution for integrated diagnosis of NTDs, particularly for those requiring mass drug administration (MDA) as primary control and elimination strategy. This scoping review aims (i) to provide an overview of assays using serum or plasma to detect infections with soil-transmitted helminths (STHs) in both humans and animals, (ii) to examine the methodologies used in this research field and (iii) to discuss advancements in serological diagnosis of STHs to guide prevention and control programs in veterinary and human medicine.

METHODOLOGY

We conducted a systematic search in the Ovid MEDLINE, Embase and Cochrane Library databases, supplemented by a Google search using predefined keywords to identify commercially available serological assays. Additionally, we performed a patent search through Espacenet.

PRINCIPAL FINDINGS

We identified 85 relevant literature records spanning over 50 years, with a notable increased interest in serological assay development in recent years. Most of the research efforts concentrated on diagnosing Ascaris infections in both humans and pigs, primarily using ELISA and western blot technologies. Almost all records targeted antibodies as analytes, employing proteins and peptides as analyte detection agents. Approximately 60% of sample sets described pertained to human samples. No commercially available tests for Trichuris or hookworms were identified, while for Ascaris, there are at least seven different ELISAs on the market.

CONCLUSIONS

While a substantial number of assays are employed in epidemiological research, the current state of serological diagnosis for guiding STH prevention and control programs is limited. Only two assays designed for pigs are used to inform efficient deworming practices in pig populations. Regarding human diagnosis, none of the existing assays has undergone extensive large-scale validation or integration into routine diagnostics for MDA programs.

Trichuris muris as a tool for holistic discovery research: from translational research to environmental bio-tagging

Trichuris spp. (whipworms) are intestinal nematode parasites which cause chronic infections associated with significant morbidities. Trichuris muris in a mouse is the most well studied of the whipworms and research on this species has been approached from a number of different disciplines. Research on T. muris in a laboratory mouse has provided vital insights into the host–parasite interaction through analyses of the immune responses to infection, identifying factors underpinning host susceptibility and resistance. Laboratory studies have also informed strategies for disease control through anthelmintics and vaccine research. On the contrary, research on naturally occurring infections with Trichuris spp. allows the analysis of the host–parasite co-evolutionary relationships and parasite genetic diversity. Furthermore, ecological studies utilizing Trichuris have aided our knowledge of the intricate relationships amongst parasite, host and environment. More recently, studies in wild and semi-wild settings have combined the strengths of the model organism of the house mouse with the complexities of context-dependent physiological responses to infection. This review celebrates the extraordinarily broad range of beneficiaries of whipworm research, from immunologists and parasitologists, through epidemiologists, ecologists and evolutionary biologists to the veterinary and medical communities.

Bethony J. Diagnostic performance of urinary IgG antibody detection: A novel approach for population screening of strongyloidiasis

The diagnosis of strongyloidiasis by coprological methods has a low sensitivity, underestimating the prevalence of Strongyloides stercoralis in endemic areas. Serodiagnostic tests for strongyloidiasis have shown robust diagnostic properties. However, these methods require a blood draw, an invasive and labor-intensive sample collection method, especially in the resource-limited settings where S. stercoralis is endemic. Our study examines a urine-based assay for strongyloidiasis and compares its diagnostic accuracy with coprological and serological methods. Receiver operating characteristic (ROC) curve analyses determined the diagnostic sensitivity (D-Sn) and specificity (D-Sp) of the urine ELISA, as well as estimates its positive predictive value and diagnostic risk. The likelihood ratios of obtaining a positive test result (LR+) or a negative test result (LR-) were calculated for each diagnostic positivity threshold. The urine ELISA assay correlated significantly with the serological ELISA assay for strongyloidiasis, with a D-Sn of 92.7% and a D-Sp of 40.7%, when compared to coprological methods. Moreover, the urine ELISA IgG test had a detection rate of 69%, which far exceeds the coprological method (28%). The likelihood of a positive diagnosis of strongyloidiasis by the urine ELISA IgG test increased significantly with increasing units of IgG detected in urine. The urine ELISA IgG assay for strongyloidiasis assay has a diagnostic accuracy comparable to serological assay, both of which are more sensitive than coprological methods. Since the collection of urine is easy and non-invasive, the urine ELISA IgG assay for strongyloidiasis could be used to screen populations at risk for strongyloidiasis in S. stercoralis endemic areas.

Population expansion and individual age affect endoparasite richness and diversity in a recolonising large carnivore population

The recent recolonisation of the Central European lowland (CEL) by the grey wolf (Canis lupus) provides an excellent opportunity to study the effect of founder events on endoparasite diversity. Which role do prey and predator populations play in the re-establishment of endoparasite life cycles? Which intrinsic and extrinsic factors control individual endoparasite diversity in an expanding host population? In 53 individually known CEL wolves sampled in Germany, we revealed a community of four cestode, eight nematode, one trematode and 12 potential Sarcocystis species through molecular genetic techniques. Infections with zoonotic Echinococcus multilocularis, Trichinella britovi and T. spiralis occurred as single cases. Per capita endoparasite species richness and diversity significantly increased with population size and changed with age, whereas sex, microsatellite heterozygosity, and geographic origin had no effect. Tapeworm abundance (Taenia spp.) was significantly higher in immigrants than natives. Metacestode prevalence was slightly higher in ungulates from wolf territories than from control areas elsewhere. Even though alternative canid definitive hosts might also play a role within the investigated parasite life cycles, our findings indicate that (1) immigrated wolves increase parasite diversity in German packs, and (2) prevalence of wolf-associated parasites had declined during wolf absence and has now risen during recolonisation.

Patterns in parasite epidemiology: the peak shift

A characteristic relationship between infection and host age, with levels of infection reaching a peak in particular age classes, has been reported for many parasites. However, several field studies have shown that this relationship is not invariant: if age-infection data are compared across host populations, the peak level of infection is higher and occurs at a younger age when the transmission rate is high, and is lower and occurs at an older age when it is low. This pattern is called the ;peak shift'. Here, Mark Woolhouse reviews the evidence for and the implications of the peak shift. The peak shift is consistent with the predictions of mathematical models that assume gradually acquired protective immunity, and this interpretation is supported by experimental studies using animals. This agreement between theory, experimental evidence and field studies strongly suggests that acquired immunity has a major impact on epidemiological patterns not only for parasites such as malaria, where the importance of acquired immunity is not in doubt, but also for many parasitic helminths, where the role of acquired immunity is less widely accepted.

Geohelminth infections: a review of the role of IgE and assessment of potential risks of anti-IgE treatment

Geohelminth infections are major parasitic infections with a worldwide distribution. Immunoglobulin E (IgE) is considered to play a central role in protective immunity against these parasites although the evidence from experimental animal models infected with helminth parasites and treated with anti-IgE antibodies and from observational studies in human populations of the immunologic correlates of protective immunity against helminths do not support a critical role for IgE in mediating protection against helminths. Anti-IgE treatment of human allergic disorders using a humanized monoclonal IgE antibody (omalizumab, Xolair) has been approved for clinical use in the USA and Europe and there is concern that this treatment may be associated with increased morbidity in populations exposed to helminth infections. A recently published randomized controlled trial investigating the risk of geohelminth infections in allergic patients receiving omalizumab in Brazil has provided some evidence that omalizumab may not be associated with increased morbidity attributable to these parasites. This review examines the evidence for a role of IgE in protective immunity against helminth parasites, discusses the findings of the randomized controlled trial, assesses the potential risks and provides recommendations for anti-IgE treatment in groups of allergic patients with different exposure risks for helminth infections.

Immunoepidemiology of Wuchereria bancrofti infection: parasite transmission intensity, filaria-specific antibodies, and host immunity in two East African communities

We compared the age profiles of infection and specific antibody intensities in two communities with different transmission levels in East Africa to examine the contribution of humoral responses to human immunity to the vector-borne helminth Wuchereria bancrofti. The worm intensities were higher and exhibited a nonlinear age pattern in a high-transmission community, Masaika, in contrast to the low but linearly increasing age infection profile observed for a low-transmission community, Kingwede. The mean levels of specific immunoglobulin G1 (IgG1), IgG2, IgG4, and IgE were also higher in Masaika, but intriguingly, the IgG3 response was higher in Kingwede. The age-antibody patterns differed in the two communities but in a manner apparently contrary to a role in acquired immunity when the data were assessed using simple correlation methods. By contrast, multivariate analyses showed that the antibody response to infection may be classified into three types and that two of these types, a IgG3-type response and a response measuring a trade-off in host production of IgG4 and IgG3 versus production of IgG1, IgG2, and IgE, had a negative effect on Wuchereria circulating antigen levels in a manner that supported a role for these responses in the generation of acquired immunity to infection. Mathematical modeling supported the conclusions drawn from empirical data analyses that variations in both transmission and worm intensity can explain community differences in the age profiles and impacts of these antibody response types. This study showed that parasite-specific antibody responses may be associated with the generation of acquired immunity to human filarial infection but in a form which is dependent on worm transmission intensity and interactions between immune components.

AGE-DEPENDENT EPIDEMIOLOGICAL PATTERNS AND STRAIN DIVERSITY IN HELMINTH PARASITES

Field studies of schistosomes and the major intestinal nematodes Trichuris trichiura and Ascaris lumbricoides repeatedly demonstrate that the intensity and prevalence of infection exhibit marked dependency on host age. Peak levels of infection typically occur in hosts aged between 10 and 14 yr in endemically infected communities. It has widely been assumed that the slow acquisition of resistance in adults is caused by repeated exposure to the same antigenic repertoire of a single parasite strain. Consequently, these empirical patterns have previously been taken to suggest that human immunity to helminth parasites confers poor protection against reinfection. Here, an alternative explanation is suggested on the basis of results from a simplified model of helminth transmission. It is proposed that the empirical observations can be attributed to the circulation of multiple helminth strains that each elicit highly protective immunity. If this hypothesis is correct, estimates of epidemiological parameters from field data and the potential for control of helminth diseases might require reevaluation.

A comparison of local and peripheral parasite-specific antibody production in different strains of mice infected with Trichuris muris

The serum parasite-specific antibody responses of different mouse strains infected with Trichuris muris reflect the nature of the T-helper response mounted by the host, in that resistant Th2-responding strains, such as BALB/K, produce immunoglobulin (Ig)G1 and susceptible predominantly Th1-responding strains, such as AKR, produce IgG2a and IgG1. However, the kinetics of antibody production in the sera, as determined by enzyme-linked immunosorbent assay, do not reflect infection status in that resistant strains can expel their worm burdens before antibodies are detectable in the sera. Here, we show that parasite-specific antibody production by in vitro lipopolysaccharide-stimulated mesenteric lymph node cells (MLN) not only correlate with serum antibody isotypes, but also follow expulsion kinetics. Additionally, the antibody levels seen locally match changes in absolute B220+ cell numbers in the MLN (determined by flow cytometry) and changes in MLN parasite-specific plasma cells in the MLN (determined by ELISPOT). These results show that B cell responses are tightly regulated locally in both resistant and susceptible strains of mice infected with T. muris.

A comparison of cellular and humoral immune responses to trichuroid derived antigens in human trichuriasis

Individuals, residing in a region highly endemic for Trichuris trichiura, were examined for cytokine and proliferative responses to T. trichiura worm homogenate (TtAg), T. trichiura excretory/secretory products (TtES) and the equivalent antigenic preparations from the murine whipworm, Trichuris muris. Serum antibody levels against TtAg, T. muris worm homogenate and T. muris ES products were also studied. Measurable levels of immunoglobulin (Ig)G1, IgG4, IgA and IgE against T. muris antigens were detected, indicating a degree of conservation of epitopes between antigens derived from both species. Although levels of interleukin (IL)-4, IL-10, IL-13, tumour necrosis factor (TNF)-alpha and proliferative responses produced were comparable between homogenate antigens of either species and ES antigens of either species, a markedly different cellular response was observed in cultures stimulated with homogenate antigens compared to ES antigens. ES antigens preferentially induced IL-10 (P > 0.001) and TNF-alpha (P > 0.001) production, whereas levels of IL-4 (P > 0.001), IL-13 (P > 0.001) and proliferative responses (P > 0.001) were greater in cultures stimulated with whole worm extracts. Our findings suggest that T. muris preparations could be used as an alternative to T. trichiura proteins as a source of antigens in ex vivo cultures and that ES products stimulate a distinct immune response compared to somatic antigens.

Human Trichuris-specific antibody responses in vaccinated hu-PBL-SCID mice

Trichuris trichiura is a highly prevalent intestinal helminth of humans with a well-characterized animal model, Trichuris muris in the mouse. Relating the murine work back to the human infection has been difficult, however, as many of the questions addressed in the mouse cannot be asked in humans. The ability to reconstitute a mouse with a human immune system could help bridge this gap, allowing a human immune response to be studied under a controllable laboratory environment. In this study, we demonstrate that severe combined immunodeficient mice engrafted with naïve human peripheral blood lymphocytes are capable of mounting a Trichuris specific human antibody response after vaccination with T. muris antigens. The phenotype of the response depended on the vaccinating antigen with excretory/secretory antigens eliciting a human immunoglobulin IgG2 response, and whole worm homogenate stimulating IgG1 and IgG2 responses. Vaccination with homogenate also enhanced a human IgG response against a 66-kDa component of T. muris homogenate in a donor-dependent manner. This work shows the potential of using the humanized mouse model for studying the immune responses of humans living in T. trichiura endemic areas.

Decline in total serum IgE after treatment for tuberculosis

BACKGROUND

Infection with Mycobacterium tuberculosis induces a type-1 immune response, whereas intestinal parasites elicit a type-2 response. Given that type-1 and type-2 responses inhibit each other, we investigated if M tuberculosis downregulates serum IgE, a marker of a type-2 response.

METHODS

A prospective study was done in the Western Cape Province of South Africa, where tuberculosis and intestinal-parasite infection are common. Total serum IgE was determined for 37 controls and for 33 adolescent patients at presentation with tuberculosis and after successful completion of treatment. IgE specific for ascaris and allergens were measured in a subset of these individuals. Mantoux skin tests were done on 35 controls and on 31 patients at diagnosis.

FINDINGS

Total IgE concentrations were high in controls (mean 313 kU/L) and in patients before treatment (mean 457 kU/L, p=0.085) and declined in all patients following successful treatment (mean 175 kU/L, p<0.0001). Posttreatment IgE concentrations did not differ from concentrations in controls. Ascaris-specific IgE was lower in controls (mean 1.73 kU/L) than in patients before treatment (4.62 kU/L, p=0.023) and was 2.39 kU/L in patients after treatment (p=0.0625). Tuberculin induration correlated inversely with IgE in patients but not in controls.

INTERPRETATION

Infection with M tuberculosis as such is not incompatible with a prominent IgE response. IgE concentrations decreased after successful treatment of tuberculosis, showing that IgE concentrations in human beings can be downregulated under these circumstances, presumably due to enhancement of a type-1 response.

A stochastic model of schistosomiasis immuno-epidemiology

Schistosomiasis is a helminth (worm) infection with approximately 200 million people infected worldwide. There is still controversy on whether differing worm burdens between individuals is a result of differing contact rates or of acquired immunity. In this paper, we present a stochastic modelling framework to address these issues. By using appropriate approximations for the higher moments of the joint distributions, differential equations for the means, variances and co-variances of infection and immunity can be obtained. Numerical solutions of these equations to obtain age profiles of the above properties were compared with Monte Carlo simulations of the stochastic process. Simulations showed that the results depended on whether between host heterogeneity was generated by differing contact rates or differing immune responses. Heterogeneity in contact rates produced a highly aggregated distribution of parasites with a large variance/mean ratio. Heterogeneity in the immune response had very little effect on the overall dynamics. This agrees with the predominant field evidence which would suggest that infection is mainly determined by ecology with a smaller contribution of immunity.

Humoral responses in human strongyloidiasis: correlations with infection chronicity

Strongyloides stercoralis L3-specific antibody isotype responses amongst individuals with known long-standing (28-46 years) infection were compared with those of 'young' (6-29 years of age) and 'old' (30-80 years of age) infected individuals from an endemic Jamaican population. Characterization of age-dependent isotype patterns in the endemic community showed that immunoglobulin (Ig) G1 responses were significantly inversely correlated with age. Additionally, a trend towards lower IgE levels in the older age group was observed. Comparison with responses amongst known chronically infected individuals showed that IgG1 and IgE levels were similar to those of the 'old' endemic group, but were significantly lower than those of the 'young' group. In contrast, IgA levels were similar in both endemic groups, but were elevated in chronically infected individuals. IgG4 levels were similar in all groups studied. These findings suggest that age correlates with infection chronicity in communities endemic for S. stercoralis, and that individuals acquire infection early in their lives and remain infected into adulthood. Early and sustained upregulation of IgG4 may facilitate the establishment of infection and, in combination with developing IgE hyporesponsiveness, may promote chronic asymptomatic strongyloidiasis. Conversely, upregulated IgA may be involved in controlling chronic infection levels which are reflected in reduced IgG1 production.

Potential for diagnosis of intestinal nematode infections through antibody detection in saliva

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.

Antibody isotype responses to antigens of Ascaris lumbricoides in a case-control study of persistently heavily infected Bangladeshi children

Antibody responses to Ascaris lumbricoides worm antigens were examined by ELISA in a case-control study of 2 groups of Bangladeshi children, one of which had been shown over a period of 12 months to be consistently lightly infected (controls) and the other consistently heavily infected (cases). The children showed a wide range in intensity of infection; children identified as cases were on average 4 times more heavily infected than the controls. There were no significant differences in weight, height, mid-upper arm circumference and skinfold thickness between the case or control subjects at the time blood samples for analyses by ELISA were collected. Children with repeatedly heavy infections with A. lumbricoides had higher concentrations of antibody isotypes to the antigens of A. lumbricoides than children who are repeatedly lightly infected. IgG1, IgG4 and IgE to worm antigens occurred in significantly higher concentrations in heavily infected subjects. This suggests that these antibody responses simply reflect the intensity of infection and may not play a significant role in protecting against heavy infections.

Immunoepidemiology of human necatoriasis: correlations between antibody responses and parasite burdens

In this paper we describe the relationship between antibodies to Necator americanus stage-specific antigens and parasite burden in an endemically-infected population in Papua New Guinea. Using an age-structured analysis, we show that the correlation coefficient between levels of IgG against adult worm excretory-secretory (ES) antigen and parasite burden declined significantly with host age from positive in younger hosts to significantly negative in older hosts. A trend towards similar patterns was present for anti-larval IgG both pretreatment and after reinfection, and for anti-ES IgM and anti-ES IgE pretreatment. These patterns are consistent with a role for these isotypes in a protective immune response, although parasite-induced immunosuppression may provide an alternate explanation. This is another demonstration of possibly protective responses to N. americanus infection.

Immunity in humans to Necator americanus: IgE, parasite weight and fecundity

The effect of the humoral immune response on the weight and fecundity of the hookworm Necator americanus was examined in an endemically-infected human population. There was a highly significant negative correlation between total IgE levels and parasite weight and fecundity, after controlling for any effects of host age and hookworm burden. This correlation was present both at initial treatment and after 2 years' reinfection. There was a similar negative correlation between the number of eosinophils and hookworm weight and fecundity at initial treatment. Correlations with levels of specific antibodies to N. americanus excretory-secretory products were weaker and not significant, although there was a trend towards negative correlations with anti-ES IgE. This is the first field evidence for an effective human immune response to N. americanus. Although the mechanism of this effect is not clear, we suggest that total IgE levels reflected the level of Th2 cell activation.

Identification and characterization of excreted/secreted products of Trichuris trichiura

This study provides the first description of the range and immunogenicity of proteins excreted and/or secreted by living T. trichiura adult worms following their recovery from the human large intestine. Metabolic labelling of T. trichiura excretory/secretory (ES) products with [35S]-methionine revealed a range of proteins with prominent components at 52-54 kDa, 35-45 kDa & 17 kDa. In contrast, the major component of unlabelled T. trichiura ES, somatic whole worm and isolated stichosome extracts, and of [35S]-methionine labelled somatic extracts, was present at approximately 47 kDa. Similarly, the major 43 kDa protein present in unlabelled T. muris ES, somatic worm extract and [35S]-methionine labelled somatic worm extract, was only weakly detected in labelled T. muris ES. Pulse chase experiments demonstrated that after 20 h, the 43 kDa was a prominent component of T. muris ES. These data suggest that the 43/47 kDa protein of Trichuris adult worms is not a major constituent of newly synthesized ES but is either synthesized at a slower rate than other proteins, or sequestered or stored, most likely in the stichocytes, before release. Immunoprecipitations using a range of sera from T. trichiura-infected individuals demonstrated that many of the ES components are immunogenic. Antibody responses were vigorous in children with intense infections and negligible in parasitologically negative children. There was marked heterogeneity in responses to a 17 kDa antigen, with the age profile of anti-17 kDa antibody levels reflecting age-dependent infection intensities at the population level.

Comparison of age-dependent antigen recognition in two communities with high and low Trichuris trichiura transmission

A previous ELISA-based study using whole worm extract, compared age-antibody profiles in two communities with high and low levels of Trichuris trichiura transmission (Needham et al., 1992). This showed that specific IgG1 levels mirrored infection intensity at the population level, while IgA levels exhibited a weak trend to remain elevated in the adult age classes in the area of highest transmission. This was interpreted as preliminary evidence for IgA-mediated resistance in the population with greatest prior experience of infection. The present study extends this work to compare IgG1 and IgA isotype recognition of separated antigens by Western blot between the two communities. Comparison of age-dependent antigen recognition in the two communities shows that both qualitative and quantitative recognition by IgG1 antibodies is related to the current intensity of infection (as assessed by eggs per gram of faeces, epg). The magnitude of the IgA response to separated antigens of 16-17 kDa and 90 kDa exhibits a stronger trend to remain elevated in adults and to reflect the past experience of infection: IgA antibodies are present at significantly higher levels in adults from the high transmission area compared with those from the community with low levels of T. trichiura endemicity, despite infection levels in these age groups being of similar magnitude. This comparative study therefore, provides further evidence to support a role for IgA in acquired immunity to T. trichiura in areas of intense transmission.

Temporal changes in Trichuris trichiura infection intensity and serum isotype responses in children

The present study describes Trichuris trichiura infections in a cohort of children over a period of approximately 5 years, and examines the relationships between changes in infection intensity and changes in parasite-specific isotype responses (measured by ELISA). The decrease in mean infection intensity with time was mirrored by time-dependent changes in IgG subclass responses, with IgA and IgE levels remaining relatively constant in the cohort. At the individual level, changes in infection intensity between the initial and final time-points correlated positively and significantly with changes in all isotype levels with the exception of IgA.

Immunoepidemiology of intestinal helminthic infections. 2. Immunological correlates with patterns of Trichuris infection

The significance of parasite-specific serum and secretory immunoglobulin (Ig) isotype responses as determinants of Trichuris trichiura infection intensity in endemic communities is discussed. Comparison of age-dependent isotype responses and the age profiles of infection intensity in 2 endemic communities with markedly different levels of T. trichiura transmission suggest that serum IgA responses may reflect the accumulated past experience of infection and thus may be relevant in acquired immunity to T. trichiura and contribute to the age-convexity of infection intensity in areas of intense transmission. Preliminary analysis of data from a second community-based study shows that parasite-specific secretory IgA in saliva increases with age and correlates negatively with infection intensity, suggesting that secretory IgA may also be implicated in acquired immunity to this gut-dwelling nematode.

Immunoepidemiology of intestinal helminthic infections. 3. Mucosal macrophages and cytokine production in the colon of children with Trichuris trichiura dysentery

Mucosal macrophages and accessory cells have been studied by immunohistochemistry in the lamina propria of the colon of children with Trichuris trichiura dysentery syndrome (TDS). No difference was found in the numbers of cells recognized by the monoclonal antibodies CD11c, CD68, or RFD7 between TDS children and local controls. However, large numbers of cells were recognized by an antibody against calprotectin (an anti-bacterial glycoprotein found in tissue infiltrating-monocytes) in TDS colonic mucosa, but few in control colon. Large numbers of cells containing tumour necrosis factor alpha (TNF alpha) were also seen in TDS mucosa; cells isolated from TDS mucosa secreted more TNF alpha than cells from control mucosa; and children with TDS had high levels of circulating TNF alpha. Non-specific macrophage-mediated inflammation and local cytokine production may therefore play a role in the pathogenesis of TDS.

Age-dependency of serum isotype responses and antigen recognition in human whipworm (Trichuris trichiura) infection

The present study examines the age-dependency of parasite-specific isotype responses and antigen recognition profiles of individuals within a Trichuris trichiura endemic community, in order to evaluate the significance of serum antibodies as determinants of observed age-related patterns of infection intensity. A high degree of individual heterogeneity is observed in isotype responses to separated T. trichiura antigens by Western blot. Recognition by IgG1 antibodies exhibits marked age-dependency. The age-profiles of IgG1 responses to selected antigens of 16-17 kDa and 90 kDa molecular weight reflect the age-related changes in current infection intensity at the population level. Similarly, mean age patterns of IgG2 responses to a 90 kDa antigen, and mean IgG4 responses to a 16-17 kDa antigen reflect mean infection levels. IgG3 responses are negligible, and for methodological reasons, both IgE and IgM specificities are not presented. IgA responses to separated antigens of 16-17 kDa and 90 kDa, exhibit age-profiles which may suggest the development of an IgA-mediated acquired resistance to T. trichiura with age. IgA levels remain elevated throughout early adulthood, when infection intensity levels markedly decrease, supporting the hypothesis that IgA antibodies may be significant in generating the convex nature of the age-infection profile of T. trichiura.

Immunological modulation and evasion by helminth parasites in human populations

Helminth parasites are highly prevalent in human communities in developing countries. In an endemic area an infected individual may harbour parasitic worms for most of his or her life, and the ability of these infections to survive immunological attack has long been a puzzle. But new techniques are starting to expose the diverse mechanisms by which these agents modulate or evade their hosts' defences, creating a dynamic interaction between the human immune system and the parasite population.