Host-Parasite Interactions in Individuals with Type 1 and 2 Diabetes Result in Higher Frequency of Ascaris lumbricoides and Giardia lamblia in Type 2 Diabetic Individuals

Burden of intestinal parasites among diabetic patients in Africa: a systematic review and meta-analysis

BACKGROUND

Intestinal parasite infections remain a serious public health concern around the world, particularly in countries with inadequate sanitation. The study aims to ascertain the total magnitude of intestinal parasites in diabetes patients throughout the African countries.

OBJECTIVE

The aim of this systematic review and meta-analysis was to determine the general burden of intestinal parasites among diabetic patients in Africa.

METHODS

A systematic search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol for studies reporting intestinal parasite infections in patients with diabetes through January 01/2000 to August13/2024. The collected data were analyzed using STATA software version 17. Seven case-control studies and nine cross-sectional studies were included in this study. Heterogeneity across studies was assessed using Cochran's Q statistic and I2 statistics. Subgroup analysis was carried out when the I2 value exceeded 50%, indicating substantial heterogeneity.

RESULTS

In the current systematic review and meta-analysis, the pooled prevalence of intestinal parasites in diabetic patients was 31% (95% CI: 23-38%) with heterogeneity of I2 = 95.94%; P < 0.001. The highest prevalence based on geographical area was in region of the Egypt 39% (95% CI: 26-52%), and based on study design was in case control studies 40% (95% CI: 28-52%). Poor hygiene and sanitation(P < 0.001), as well as diabetes mellitus status (P < 0.001), were statistically significant factors associated with patients who have diabetes.

CONCLUSION

Patients with diabetes are a high-risk group for intestinal parasitic infections and should be prioritized for screening. Therefore, it is essential to implement preventative measures for these patients.

The Influence of the Protozoan Giardia lamblia on the Modulation of the Immune System and Alterations in Host Glucose and Lipid Metabolism

Giardia lamblia, the cause of giardiasis, significantly impacts patients with metabolic disorders related to insulin resistance (IR). Both giardiasis and metabolic disorders share elements such as chronic inflammation and intestinal dysbiosis, which substantially affect the metabolic and cytokine profiles of patients. This review discusses the mechanisms of virulence of G. lamblia, its influence on the immune system, and its association with metabolic disorders. The review aims to show how G. lamblia invasion acts on the immune system and the glucose and lipid metabolism. Key findings reveal that G. lamblia infection, by disrupting intestinal permeability, alters microbiota composition and immune responses, potentially impairing metabolic status. Future research should focus on elucidating the specific mechanisms by which G. lamblia influences the metabolism, exploring the long-term consequences of chronic infection, and developing targeted therapeutic strategies that include both parasitic and metabolic aspects. These insights underscore the need for a multidisciplinary approach to the treatment of giardiasis in patients with metabolic disorders.

Presence of Intestinal Parasites in Patients with Chronic Non-Communicable Diseases in Masaya (Nicaragua)

AIMS

A cross-sectional study was conducted in Masaya (Nicaragua) to estimate the prevalence of intestinal parasite (IP) infections in patients with non-communicable diseases (NCDs) and to determine the associations between the types of NCDs and patients' epidemiological characteristics of infection.

METHODS

A total of 157 preserved faecal samples were examined (direct wet mount, formalin/ethyl acetate concentration and modified Ziehl-Neelsen technique). Microscopically positive faecal sample identification was completed by conducting a molecular study.

RESULTS

The total prevalence of IP was 52% in NCD patients. Diabetic patients presented an IP prevalence of 42%. Blastocystis presented the highest prevalence (42%). A molecular analysis of Giardia intestinalis (prevalence of 1.3%) revealed 100% of sub-assemblage BIII and the Entamoeba complex (5%) was identified as E. dispar. Blastocystis ST1 appeared in 44% of those suffering from diabetes and ST3 in 66% of those suffering from hypertension, while ST2 only appeared in those suffering with several NCDs simultaneously. In diabetic patients, the risk of infection is associated with having pets (p = 0.021) and land-floor houses. The risk of infection appears to be statistically related (p = 0.019) in those with several NCDs having received a previous helminthic deworming treatment.

CONCLUSIONS

Coordinated public health activities for IP and NCD screening and diagnosis are crucial to their successful control programmes.

Effect of macrophage polarization on parasitic protection against type 1 diabetes mellitus

Type 1 diabetes mellitus is a chronic disease caused by the destruction of pancreatic beta cells. Based on the hygiene hypothesis, a growing body of evidence suggests a negative association between parasitic infections and diabetes in humans and animal models. The mechanism of parasite-mediated prevention of type 1 diabetes mellitus may be related to the adaptive and innate immune systems. Macrophage polarization is a new paradigm for the treatment of type 1 diabetes mellitus, and different host macrophage subsets play various roles during parasite infection. Proinflammatory cytokines are released by M1 macrophages, which are important in the development of type 1 diabetes mellitus. Parasite-activated M2 macrophages prevent the development of type 1 diabetes mellitus and can influence the development of adaptive immune responses through several mechanisms, including Th2 cells and regulatory T cells. Here, we review the role and mechanism of macrophage polarization in parasitic protection against type 1 diabetes mellitus.

Enteric Protozoan Parasitosis and Associated Factors among Patients with and without Diabetes Mellitus in a Teaching Hospital in Ghana

Background

Enteric protozoa infections (EPIs) could worsen clinical outcomes in patients with diabetes mellitus and therefore requires prompt and accurate diagnosis and attention. This study aimed to determine the burden of EPIs and their associated factors among patients with and without diabetics at the Komfo Anokye Teaching Hospital (KATH) in Ghana. Again, the diagnostic performance of parasitological techniques routinely used for diagnosis was assessed.

Methods

A total of 240 participants (made up of 140 patients with diabetes and 100 patients without diabetes) were recruited into the study by simple random sampling from November 2020 to May 2021. Stool samples of participants were collected, along with their demographic information, and examined using the saline direct wet mount (DWM), formol-ether concentration (FEC), and modified Ziehl-Neelsen staining (ZNS) techniques for the presence of enteric protozoans.

Results

Enteric protozoa were found among 62/140 (44.3%) diabetic patients and 13/100 (13.0%) nondiabetic patients. The predominant protozoa identified were Cryptosporidium spp. (17.86%) among patients with diabetes and Blastocystis hominis (7.0%) among patients without diabetes. EPI was associated with diabetes mellitus status (AOR = 3.48, 95% CI, 1.55-7.79), having diabetes for more than five years (AOR = 3.83, 95% CI, 1.65-8.86) and having comorbidity (AOR = 2.93, 95% CI, 1.33-6.45). The FEC technique had the highest sensitivity (100.0%), specificity 94.3% (95% CI, 91.35-97.22), and accuracy 95.0% (95% CI, 88.54-98.13) when compared to other techniques for diagnosis.

Conclusion

EPIs are a significant health problem among patients with diabetes at KATH, and therefore antiparasitic drugs should be included in their treatment protocols for better health outcomes. Again, the FEC technique has demonstrated better performance in detecting EPIs and is therefore recommended to achieve early and accurate diagnosis of EPIs.

Effects of helminths and anthelmintic treatment on cardiometabolic diseases and risk factors: A systematic review

BACKGROUND

Globally, helminth infections and cardiometabolic diseases often overlap in populations and individuals. Neither the causal relationship between helminth infections and cardiometabolic diseases nor the effect of helminth eradication on cardiometabolic risk have been reviewed systematically in a large number of human and animal studies.

METHODS

We conducted a systematic review assessing the reported effects of helminth infections and anthelmintic treatment on the development and/or severity of cardiometabolic diseases and risk factors. The search was limited to the most prevalent human helminths worldwide. This study followed PRISMA guidelines and was registered prospectively in PROSPERO (CRD42021228610). Searches were performed on December 10, 2020 and rerun on March 2, 2022 using Ovid MEDLINE ALL (1946 to March 2, 2022), Web of Science, Cochrane Library, Global Index Medicus, and Ovid Embase (1974 to March 2, 2022). Randomized clinical trials, cohort, cross-sectional, case-control, and animal studies were included. Two reviewers performed screening independently.

RESULTS

Eighty-four animal and human studies were included in the final analysis. Most studies reported on lipids (45), metabolic syndrome (38), and diabetes (30), with fewer on blood pressure (18), atherosclerotic cardiovascular disease (11), high-sensitivity C-reactive protein (hsCRP, 5), and non-atherosclerotic cardiovascular disease (4). Fifteen different helminth infections were represented. On average, helminth-infected participants had less dyslipidemia, metabolic syndrome, diabetes, and atherosclerotic cardiovascular disease. Eleven studies examined anthelmintic treatment, of which 9 (82%) reported post-treatment increases in dyslipidemia, metabolic syndrome, and diabetes or glucose levels. Results from animal and human studies were generally consistent. No consistent effects of helminth infections on blood pressure, hsCRP, or cardiac function were reported except some trends towards association of schistosome infection with lower blood pressure. The vast majority of evidence linking helminth infections to lower cardiometabolic diseases was reported in those with schistosome infections.

CONCLUSIONS

Helminth infections may offer protection against dyslipidemia, metabolic syndrome, diabetes, and atherosclerotic cardiovascular disease. This protection may lessen after anthelmintic treatment. Our findings highlight the need for mechanistic trials to determine the pathways linking helminth infections with cardiometabolic diseases. Such studies could have implications for helminth eradication campaigns and could generate new strategies to address the global challenge of cardiometabolic diseases.

Infections and immunity: associations with obesity and related metabolic disorders

About one-fourth of the global population is either overweight or obese, both of which increase the risk of insulin resistance, cardiovascular diseases, and infections. In obesity, both immune cells and adipocytes produce an excess of pro-inflammatory cytokines that may play a significant role in disease progression. In the recent coronavirus disease 2019 (COVID-19) pandemic, important pathological characteristics such as involvement of the renin-angiotensin-aldosterone system, endothelial injury, and pro-inflammatory cytokine release have been shown to be connected with obesity and associated sequelae such as insulin resistance/type 2 diabetes and hypertension. This pathological connection may explain the severity of COVID-19 in patients with metabolic disorders. Many studies have also reported an association between type 2 diabetes and persistent viral infections. Similarly, diabetes favors the growth of various microorganisms including protozoal pathogens as well as opportunistic bacteria and fungi. Furthermore, diabetes is a risk factor for a number of prion-like diseases. There is also an interesting relationship between helminths and type 2 diabetes; helminthiasis may reduce the pro-inflammatory state, but is also associated with type 2 diabetes or even neoplastic processes. Several studies have also documented altered circulating levels of neutrophils, lymphocytes, and monocytes in obesity, which likely modifies vaccine effectiveness. Timely monitoring of inflammatory markers (e.g., C-reactive protein) and energy homeostasis markers (e.g., leptin) could be helpful in preventing many obesity-related diseases.

Intestinal parasites and diabetes: A systematic review and meta-analysis

BACKGROUND

Investigating the association between infectious agents and non-communicable diseases is an interesting emerging field of research. Intestinal parasites (IPs) are one of the causes of gastrointestinal complications, malnutrition, growth retardation and disturbances in host metabolism, which can play a potential role in metabolic diseases such as diabetes. The aim of the present study was to investigate the prevalence of IPs in diabetic patients and the association between IPs and diabetes.

METHODS

A systematic literature search was conducted from January 2000 to November 2022in published records by using PubMed, Scopus, and Web of Science databases as well as Google scholar search engine; Out of a total of 29 included studies, fourteen cross-sectional studies (2676 diabetic subjects) and 15 case-control studies (5478 diabetic/non-diabetic subjects) were reviewed. The pooled prevalence of IPs in diabetics and the Odds Ratio (OR) were evaluated by CMA V2.

RESULTS

In the current systematic review and meta-analysis, the pooled prevalence of IPs in diabetic patients was 26.5% (95% CI: 21.8-31.7%) with heterogeneity of I2 = 93.24%; P < 0.001. The highest prevalence based on geographical area was in Region of the Americas (13.3% (95% CI: 9.6-18.0)).There was significant association between the prevalence of intestinal parasites in diabetic cases compared to controls (OR, 1.72; 95% CI: 1.06-2.78).

CONCLUSION

In line with the high prevalence of IPs in diabetic patients, significant association was found however, due to the limitations of the study, more studies should be conducted in developing countries and, the prevalence of IPs in diabetics should not be neglected.

Prevalence and Associated Risk Factors of Intestinal Parasitic Infections: A Population-Based Study in Phra Lap Sub-District, Mueang Khon Kaen District, Khon Kaen Province, Northeastern Thailand

Intestinal parasitic infections are still a crucial problem among communities in Northeast Thailand. Misuse of antiparasitic drugs and unhealthy food behaviors are known. This study aimed to explore the prevalence, behavioral health factors, and motivation for self-treatment of anti-parasitic drugs in this area. A community-based cross-sectional study was conducted in Phra Lap sub-district, Mu Khon Kaen district, Khon Kaen province, Northeast Thailand, in 2016. A total of 419 participants were recruited to complete a self-administered questionnaire and stool examination. Binary logistic regression was used to assess the association between the risk factor and parasitic infection. Forty-two participants (10%; 95%CI 7.5-13.3) were positive for at least one parasite species. In this community, the most detected intestinal parasite was Opisthorchis viverrini (5.3%), followed by Strongyloides stercoralis (3.1%). A total of 67.5% of the participants had the experience of anti-parasitic drug treatment within previous 1 year, and "Often eat raw food" was the most common reason for the use of anti-parasitic drugs. On multivariate analysis, parasitic infections were significantly associated with male gender (ORadj. 2.42; 95%CI 1.00-5.85), age ≥ 60 years (ORadj. 7.55; 95%CI 1.60-35.76), and often consuming raw food of at least one type (ORadj. 2.37; 95%CI 1.03-5.44). Given these findings, correction of the dietary habit of eating raw fish/meat, which is the most important measure, and limitation of the use of anthelmintic treatment for individuals with stools positive for ova as well as emphasis on sanitary toilets will be implemented for the prevention and control of parasitic infection in endemic communities.

Importance of detection of Strongyloides stercoralis DNA in fecal samples from patients with type 2 diabetes mellitus

OBJECTIVE

The association between diabetes and Strongyloides infection remains controversial. This study aimed to detect Strongyloides stercoralis DNA in the feces of patients with Diabetes Mellitus type 2 (DM2).

METHODS

Fecal samples were analyzed via the Lutz, Rugai, and agar plate culture methods. PCR amplification was performed using two targets (PCR-genus and PCR-species) located on the S. stercoralis 18S ribosomal.

RESULTS

The positivity for S. stercoralis using parasitological methods was 1.1%. PCR-genus (14.13%) demonstrated a higher positivity than PCR-species (9.78%).

CONCLUSION

The results confirm the greater positivity of the molecular diagnosis in relation to parasitological methods, reinforcing its use as an additional tool for the diagnosis of S. stercoralis infection in patients with DM2 living in endemic areas for this helminthiasis.

Blastocystis subtypes in patients with diabetes mellitus from the Midwest region of Brazil

Blastocystis sp. is an enteric protist commonly found in human fecal samples. In Brazil, few studies have been developed, but none of them has explored the presence of Blastocystis in patients with diabetes mellitus. We evaluated the occurrence and molecular identification of Blastocystis sp. among patients with diabetes mellitus in the Midwest region, Goias State, Brazil. Genomic DNA was obtained from 175 fecal samples (99 from the diabetic group and 76 from the control group). PCR was performed using pan-Blastocystis primers from the SSU-rDNA gene. Microscopic examination revealed positivity of 12.1% and 7.9% for Blastocystis in diabetics and in controls, respectively. Amplification of Blastocystis DNA was observed in 34.4% (34 of 99) and 30.3% (23 of 76) from the diabetic and control groups, respectively. Phylogenetic analyses and BLAST searches revealed six subtypes among Blastocystis isolates in the diabetic group, represented by ST1 (38.2%), ST2 (11.8%), ST3 (35.3%), ST6 (2.9%), ST7 (2.9%) and ST8 (8.8%). In the control group, ST1 (21.8%), ST2 (21.8%), ST3 (43.5%), ST6 (4.4%) and ST8 (8.7%) were identified. This study is the first report regarding the occurrence and subtypes distribution of Blastocystis in patients with diabetes mellitus in Brazil. The results reinforce the potential risk of Blastocystis infection in patients with diabetes, in addition, it contributes to the understanding of the genetic diversity of this enigmatic organism.

Association of urogenital and intestinal parasitic infections with type 2 diabetes individuals: a comparative study

BACKGROUND

Globally, urogenital and intestinal parasitosis remain significant health challenges. They are associated with rising morbidity, death, and many harmful outcomes. A little is known concerning parasitosis and type 2 diabetes mellitus. Our study planned to investigate the urogenital and intestinal parasitic infections among type 2 diabetes patients compare to non-diabetic (Control) individuals and examine the intensity of helminthiasis in both groups.

METHODS

At Kosti Teaching Hospital (Sudan), 300 Urine and 300 stool samples have collected from 150 type 2 diabetes and 150 control individuals, along with the socio-demographic data using a structured questionnaire. The parasitic infections were examined by direct sedimentation technique for urine specimens. Whereas, for fecal samples, simple-direct saline, formal-ether concentration, Kato-Katz, and modified Ziehl-Neelsen techniques were used.

RESULTS

Out of 150 type 2 diabetes patients studied, 31 (20.6%) and 14 (9.3%) had intestinal parasitosis and urogenital schistosomiasis, respectively. Whereas, 16 (10.6%) and 8 (5.3%) of the control group were infected, respectively. Compared to the control group, the odds of testing positive for either urogenital schistosomiasis (AOR: 2.548, 95% CI: 0.836-7.761, P = 0.100) or intestinal parasitic diseases (AOR: 2.099, 95% CI: 0.973-4.531, P = 0.059) were greater in diabetic individuals. Likewise, the intensities of helminthiasis were much higher in the diabetic patients and positively correlated with the duration of illness. The rate of urogenital schistosomiasis was also significantly different among the disease duration subcategories.

CONCLUSIONS

Our study has highlighted the relationship of type 2 diabetes with urogenital and intestinal parasitic infections and enhanced our knowledge about the frequency of particular urogenital and intestinal parasites as well as the intensity of helminths infection in type 2 diabetes compared to non-diabetic individuals, which are important for further studies.

Prevalence and Subtype Distribution of Blastocystis Infection in Patients with Diabetes Mellitus in Thailand

Diabetes mellitus (DM) is a major global public health problem with an increasing prevalence. DM increases the risk of infections caused by bacteria, fungi, viruses, and parasites. We examined the prevalence, subtypes, and risk factors of Blastocystis infection in patients with and without DM in central Thailand. Stool samples and questionnaires were obtained from 130 people in the DM group and 100 people in the non-DM group. Blastocystis infection was identified via a nested polymerase chain reaction and subtyped via sequencing of the partial small-subunit ribosomal RNA (SSU rRNA) gene. Analysis of potential risk factors was conducted via binary logistic regression. The overall prevalence of Blastocystis infection was 10.8%, including rates of 9% and 12.3% in the non-DM and DM groups, respectively. The most prevalent subtype was ST3, followed by ST1, and ST4. Factors that potentially increased the risk of Blastocystis infection include patients being >65 years old, the presence of DM, a DM duration of ≥10 years, a low level of education, and animal ownership. In conclusion, this is the first study of Blastocystis infection in DM, and a high prevalence was found among this population. Therefore, health education promoting sanitation and hygiene is necessary to reduce and prevent infection in the community.

The Effects of Type 2 Diabetes Mellitus on Organ Metabolism and the Immune System

Metabolic abnormalities such as dyslipidemia, hyperinsulinemia, or insulin resistance and obesity play key roles in the induction and progression of type 2 diabetes mellitus (T2DM). The field of immunometabolism implies a bidirectional link between the immune system and metabolism, in which inflammation plays an essential role in the promotion of metabolic abnormalities (e.g., obesity and T2DM), and metabolic factors, in turn, regulate immune cell functions. Obesity as the main inducer of a systemic low-level inflammation is a main susceptibility factor for T2DM. Obesity-related immune cell infiltration, inflammation, and increased oxidative stress promote metabolic impairments in the insulin-sensitive tissues and finally, insulin resistance, organ failure, and premature aging occur. Hyperglycemia and the subsequent inflammation are the main causes of micro- and macroangiopathies in the circulatory system. They also promote the gut microbiota dysbiosis, increased intestinal permeability, and fatty liver disease. The impaired immune system together with metabolic imbalance also increases the susceptibility of patients to several pathogenic agents such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thus, the need for a proper immunization protocol among such patients is granted. The focus of the current review is to explore metabolic and immunological abnormalities affecting several organs of T2DM patients and explain the mechanisms, whereby diabetic patients become more susceptible to infectious diseases.

Is Strongyloides seropositivity associated with diabetes mellitus? A retrospective case-control study in an East London NHS Trust

BACKGROUND

The association between diabetes and Strongyloides stercoralis remains controversial. We conducted a case-control study examining the association between diabetes and Strongyloides seropositivity in a large UK centre.

METHODS

Between January 2013 and October 2016, cases and controls were identified by positive and negative Strongyloides serology, respectively. Demographic, clinical and microbiological data were retrospectively collected. Multivariate logistic regression analysis was performed.

RESULTS

Over the study period, 532 samples were serologically tested for Strongyloides. After exclusion of duplicates and cases with missing data, 100 (22.3%; 95% CI 18.5-26.4%) out of 449 tested positive. Of seropositive cases, the mean age was 57 years (SD 16), 71 (71%) were male, 94 (94%) were migrants and 92 (92%) had eosinophilia.Univariate logistic regression analysis demonstrated a significant association between Strongyloides seropositivity and age (OR 1.04, 95% CI 1.02-1.05), male sex (OR 2.22, 95% CI 1.37-3.59), migration (OR 5.36, 95% CI 2.27-12.67), eosinophilia (OR 4.36, 95% CI 2.04-9.33) and diabetes (OR 3.52, 95% CI 2.19-5.66). In multivariate analysis, there remained a significant association between diabetes and Strongyloides seropositivity (OR 1.81, 95% CI 1.04-3.16).

CONCLUSIONS

We demonstrated a high rate of Strongyloides seropositivity in our East London cohort and a significant association with diabetes.