Soil-transmitted helminth infections and leprosy: a cross-sectional study of the association between two major neglected tropical diseases in Indonesia

Oktaria, Salma; Effendi, Evita Halim; Indriatmi, Wresti; Hees, C.L.M. van; Thio, Hok Bing; Sjamsoe-Daili, Emmy Soedarmi

doi:10.1186/s12879-016-1593-0

Cited by 14 publications

(16 citation statements)

References 17 publications

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“…5,23 As both vitamin A deficiency and helminth infections are associated with suppression of the Th1 immune response, theoretically, a higher risk of T2R and possibly lower risk of T1R could be hypothesized. This fits with the results of Oktaria et al, 13 who found an increased risk of T2R in helminth-positive patients in Indonesia. Another study (Hagge et al) investigated helminth coinfection and reactions in Nepal.…”

Section: Discussionsupporting

confidence: 93%

“…[8][9][10][11][12] A recent cross-sectional study in Indonesia showed an association between soil-transmitted helminths (STH) and a higher occurrence of T2R. 13 This study also showed a higher odds of STH in multibacillary (MB) versus paucibacillary leprosy cases, an association which Diniz et al 14 also demonstrated in Brazil. On the other hand, Hagge et al 15 found a lower risk of reactions in STH-positive participants.…”

Section: Introductionmentioning

confidence: 71%

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The Burden of Helminth Coinfections and Micronutrient Deficiencies in Patients with and without Leprosy Reactions: A Pilot Study in Minas Gerais, Brazil

Fairley

Ferreira²,

Oliveira

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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Leprosy reactions are immune-mediated complications occurring in up to 50% of patients. The immune consequences of helminth infections and micronutrient deficiencies suggest a potential role in type 1 reactions (T1R) or type 2 reactions (T2R). We conducted a case-control study in Minas Gerais, Brazil, to evaluate whether comorbidities and other factors are associated with reactions in patients with multibacillary leprosy. Stool and serum were tested for helminth infections. Deficiencies of vitamin A, D, and iron were measured using serum retinol, 25-hydroxyvitamin D, and ferritin, respectively. Logistic regression models identified associations between reactions and helminth infections, micronutrient deficiencies, and other variables. Seventy-three patients were enrolled, 24 (33%) with T1R, 21 (29%) with T2R, 8 (15%) with mixed T1R/T2R, and 20 (27%) without reactions. Evidence of helminth infections were found in 11 participants (15%) and included IgG4 reactivity against Schistosoma mansoni, Strongyloides, and Ascaris antigens. Thirty-eight (52%) had vitamin D deficiency, eight (11%) had vitamin A insufficiency, 21 (29%) had anemia, and one (1.4%) had iron deficiency. Multivariable logistic regression showed no statistically significant associations between helminth coinfections and total reactions (adjusted odds ratios [aOR]: 1.36, 95% CI: 0.22, 8.33), T1R (aOR: 0.85, 95% CI: 0.17, 4.17), or T2R (aOR: 2.41, 95% CI: 0.29, 20.0). Vitamin D deficiency and vitamin A insufficiency were also not statistically associated with reactions. However, vitamin deficiencies and helminth infections were prevalent in these patients, suggesting a potential role for additional treatment interventions. Studying reactions prospectively may further clarify the role of comorbidities in the clinical presentation of leprosy.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 71%

The Burden of Helminth Coinfections and Micronutrient Deficiencies in Patients with and without Leprosy Reactions: A Pilot Study in Minas Gerais, Brazil

Fairley

Ferreira²,

Oliveira

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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“…Infection with M. leprae or M. lepromatis causes leprosy, a chronic granulomatous infectious disease. A study of Indonesian patients infected with M. lepromatis reported that those with gastrointestinal helminth infections (e.g., T. trichiura, Stongyloides sterocalis ) similarly presented with more severe types of leprosy ( 65 ).…”

Section: Effects On Bacterial Infectionsmentioning

confidence: 99%

The Influence of Parasite Infections on Host Immunity to Co-infection With Other Pathogens

Mabbott

2018

Front. Immunol.

120

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Parasites have evolved a wide range of mechanisms that they use to evade or manipulate the host's immune response and establish infection. The majority of the in vivo studies that have investigated these host-parasite interactions have been undertaken in experimental animals, especially rodents, which were housed and maintained to a high microbiological status. However, in the field situation it is increasingly apparent that pathogen co-infections within the same host are a common occurrence. For example, chronic infection with pathogens including malarial parasites, soil-transmitted helminths, Mycobacterium tuberculosis and viruses such as HIV may affect a third of the human population of some developing countries. Increasing evidence shows that co-infection with these pathogens may alter susceptibility to other important pathogens, and/or influence vaccine efficacy through their effects on host immune responsiveness. Co-infection with certain pathogens may also hinder accurate disease diagnosis. This review summarizes our current understanding of how the host's immune response to infection with different types of parasites can influence susceptibility to infection with other pathogenic microorganisms. A greater understanding of how infectious disease susceptibility and pathogenesis can be influenced by parasite co-infections will enhance disease diagnosis and the design of novel vaccines or therapeutics to more effectively control the spread of infectious diseases.

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“…Additionally, those who receive therapeutic deworming without concomitant infrastructure changes such as sanitation improvements are at high risk for re-infection within co-endemic settings. A recent small study reported microscopy STH + association with ENL ( Oktaria et al, 2016 ). Confoundingly for comparisons, however, the 8 with either active or historical ENL were grouped (two very different immunological states), all of which had received extended corticosteroid treatment prior to sampling.…”

Section: Discussionmentioning

confidence: 98%

Opening a Can of Worms: Leprosy Reactions and Complicit Soil-Transmitted Helminths

et al. 2017

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Background> 94% of new annual leprosy cases are diagnosed in populations co-endemic for soil-transmitted helminths (STH). STH can profoundly dysregulate host immune responses towards Th2 bias, which can be restored over time after deworming. We hypothesize that STH co-infection is associated with leprosy reaction (denoted as simply “reaction” herein) occurrence within a co-endemic population.MethodsA cohort study was performed on a cohort of Nepalese leprosy patients across treatment and diagnostic classifications who were screened by routine fecal smear microscopy and multiplex quantitative PCR (qPCR) for Ascaris lumbricoides (Al), Strongyloides stercoralis (Ss), Ancyclostoma duodenale (Ad) and Necator americanus (Na).ResultsAmong 145 patients, 55% were positive for ≥ 1 STH (STH +): 34% Al +, 18% Ss +, 17% Ad + and 5% Na +. Significant inverse STH and reaction relationships were evidenced by the bulk of cases: 63% reaction-negative were STH + of total cases (p = 0.030) while 65% reaction-positive were STH − in new cases (96; p = 0.023). Strikingly, the majority of STH + were reaction-negative, even when considering each species: 59% Al +, 60% Ss +, 62% Ad + and 67% Na + of new leprosy cases.ConclusionsAbsence of STH co-infection is associated with leprosy reaction at diagnosis within a co-endemic population. This is likely due to immune reconstitution effects after deworming or interruption of chronic STH-mediated immune dysregulation.

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Soil-transmitted helminth infections and leprosy: a cross-sectional study of the association between two major neglected tropical diseases in Indonesia

Cited by 14 publications

References 17 publications

The Burden of Helminth Coinfections and Micronutrient Deficiencies in Patients with and without Leprosy Reactions: A Pilot Study in Minas Gerais, Brazil

The Burden of Helminth Coinfections and Micronutrient Deficiencies in Patients with and without Leprosy Reactions: A Pilot Study in Minas Gerais, Brazil

The Influence of Parasite Infections on Host Immunity to Co-infection With Other Pathogens

Opening a Can of Worms: Leprosy Reactions and Complicit Soil-Transmitted Helminths

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