The Impact of Asymptomatic Helminth Co-Infection in Patients with Newly Diagnosed Tuberculosis in North-West Ethiopia
Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia; Department of Medical Microbiology, Linköping University, Linköping, Sweden; Medical Faculty, School of Medical Laboratory Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Department of Radiology, University of Gondar, Gondar, Ethiopia; Department of Internal Medicine, University of Gondar, Gondar, Ethiopia; Department of Parasitology, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia; Department of Infectious Diseases, Karolinska Hospital, Stockholm, Sweden; University of Southern Denmark, Institute of Molecular Medicine, Department of Cancer and Inflammation, Odense, Denmark; Armauer Hansen Research Institute, Addis Ababa, Ethiopia; Department of Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden
Background: Areas endemic of helminth infection, tuberculosis (TB) and HIV are to a large extent overlapping. The aim of this study was to assess the impact of asymptomatic helminth infection on the immunological response among TB patients with and without HIV, their house hold contacts and community controls. Methodology: Consecutive smear positive TB patients (n = 112), their household contacts (n = 71) and community controls (n = 112) were recruited in Gondar town, Ethiopia. Stool microscopy, HIV serology, serum IgE level, eosinophil and CD4 counts were performed and tuberculosis patients were followed up for 3 months after initiation of anti-TB treatment. Results: Helminth co-infection rate was 29% in TB patients and 21% in both community control and household contacts (p = 0.3) where Ascaris lumbricoides was the most prevalent parasite. In TB patients the seroprevalence of HIV was 47% (53/112). Eosinophilia and elevated IgE level were significantly associated with asymptomatic helminth infection. During TB treatment, the worm infection rate of HIV+/TB patients declined from 31% (10/32) at week 0 to 9% (3/32) at week 2 of TB treatment, whereas HIV-/TB patients showed no change from baseline to week 2, 29% (13/45) vs. 22.2% (10/45). This trend was stable at week 8 and 12 as well. Conclusion: One third of smear positive TB patients were infected with helminths. Eosinophilia and elevated IgE level correlated with asymptomatic worm infection, indicating an effect on host immunity. The rate of worm infection declined during TB treatment in HIV+/TB co-infected patients whereas no decline was seen in HIV-/TB group. © 2012 Abate et al.
immunoglobulin E; tuberculostatic agent; adolescent; adult; aged; article; Ascaris lumbricoides; asymptomatic infection; CD4 lymphocyte count; controlled study; endemic disease; eosinophilia; Ethiopia; feces analysis; female; helminth; helminthiasis; human; immune response; infection rate; major clinical study; male; mixed infection; prevalence; serology; seroprevalence; tuberculosis; worm infection; Adolescent; Adult; Aged; Animals; Antigens, CD4; Coinfection; Communicable Disease Control; Comorbidity; Ethiopia; Female; Helminthiasis; Helminths; HIV Infections; Humans; Immunoglobulin E; Infectious Disease Medicine; Male; Middle Aged; Time Factors; Tuberculosis; Ascaris lumbricoides; Vermes