|Year : 2004 | Volume
| Issue : 1 | Page : 54-56
Intestinal parasitic infection and total serum IgG in asymptomatic adult males in an urban slum and efficacy of antiparasitic therapy
S Nagaraj , R Raghavan , R Macaden , AV Kurpad
Department of Microbiology, St. John's Medical College, Bangalore - 560 034, Karnataka, India
Department of Microbiology, St. John's Medical College, Bangalore - 560 034, Karnataka, India
Malnutrition is thought to potentiate the polyclonal stimulation of IgE by parasites. This diminishes immunity due to the decrease in specific anti-parasitic IgE. Prevalence of intestinal parasitic infections in chronically undernourished, asymptomatic adult males from a slum and efficacy of anti-parasitic therapy and its effect on total serum IgE were evaluated. Stool specimens from 51 subjects were examined. Anti-helminth and anti-protozoan therapy consisted of oral, single dose albendazole (400mg) and tinidazole (2g) respectively. Total serum IgE was measured. 23 (45.1%) subjects were positive. Albendazole and tinidazole cleared intestinal parasites but had no significant effect on total serum IgE levels.
|How to cite this article:|
Nagaraj S, Raghavan R, Macaden R, Kurpad A V. Intestinal parasitic infection and total serum IgG in asymptomatic adult males in an urban slum and efficacy of antiparasitic therapy. Indian J Med Microbiol 2004;22:54-6
|How to cite this URL:|
Nagaraj S, Raghavan R, Macaden R, Kurpad A V. Intestinal parasitic infection and total serum IgG in asymptomatic adult males in an urban slum and efficacy of antiparasitic therapy. Indian J Med Microbiol [serial online] 2004 [cited 2019 Sep 23];22:54-6. Available from: http://www.ijmm.org/text.asp?2004/22/1/54/8064
Intestinal parasitosis is a major health problem in India. About 50% of the urban and 68% of rural population is affected. Slum dwellers have high rates of infestation due to poor sanitation, contaminated water supply and high population density., Their nutritional status could also be an important factor as most of them are chronically undernourished. Infection and malnutrition have a synergistic association. Immune system being an intermediary factor gets affected by this bidirectional interaction. Malnutrition is thought to potentiate IL-4 dependent polyclonal stimulation of IgE by parasites. High total serum IgE level results in decreased resistance due to low levels of specific anti-parasite IgE.
This study was undertaken to find out the prevalence of intestinal parasitic infections in asymptomatic, chronically undernourished adult males living in a slum in Bangalore, India. The efficacy of anti-parasitic therapy and total serum IgE levels before and after therapy were also assessed.
| ~ Materials and Methods|| |
Fifty-one chronically undernourished but otherwise healthy male subjects between 18 to 24 years of age from a slum in Bangalore were included in the study. Their chronic undernutrition status was determined on the basis of their BMI (less than 18.5) and low socioeconomic status. One stool specimen per subject was collected and examined for intestinal parasites within an hour. If it was found to be negative, up to three more samples were collected and examined. Iodine mount, Kato-Katz thick smear technique and formol ether concentration method were used.
Anti-helminthic and anti-protozoal therapy consisted of a single, oral dose of 400 mg albendazole and 2g tinidazole respectively., One subject who had mixed Giardia lamblia and Ascaris lumbricoides infection was treated with a combination of albendazole and tinidazole. The efficacy of the treatment was verified by microscopic examination of three consecutive stool specimens, four days after treatment.
Venous blood (5mL) was collected before and 10 days after treatment from 14 subjects who were found to be positive. Total serum IgE was measured by enzyme immunoassay (IBL, Hamburg, Germany) on an automated system (Alpha Prime, Saint Jean D-Illac, France).
Statistical analysis was done using SPSS 10.1 (SPSS inc. Chicago). Wilcoxon Signed Rank test was done. Total serum IgE levels before and after treatment were compared. Data was presented as median [interquartile range (IQR)].
| ~ Results|| |
Of the 51 subjects screened, 23 (45.1%) were positive for one or more intestinal parasites. Five subjects had mixed infections and the rest 18 had either protozoan or helminthic infections [Table]. Twenty-one subjects (91.30%) became stool negative with albendazole and/or tinidazole. Two subjects who were infected with Trichuris trichiura needed a similar second dose of albendazole to clear the helminth.
The plasma total IgE level before treatment was [median (interquartile range) :2.31 KIU/mL (0.69-4.95)] and did not show any significant decline 10 days after treatment [median (interquartile range):1.99 KIU/mL (0.83-5.25); P=0.85].
| ~ Discussion|| |
The interaction between nutritional status and infection is dynamic with host immunity being an intermediary factor. Intestinal parasitic infection not only increases nutritional requirements but also simultaneously reduces dietary intake by causing a variety of pathophysiological responses in the GI tract. The consequence of this malnutrition is impairment in host defenses resulting in increased burden of infection. This in turn aggravates the malnutrition and the cycle continues.
In India, prevalence studies on intestinal parasitosis show wide variation in their distribution depending on the setting (rural or urban), living conditions, climate, soil environment etc., The prevalence of intestinal parasitic infection among our subjects was 45.1%, which is higher than the value of 12.5% that has been reported recently, but similar to other values reported earlier. The subjects in the present study were all asymptomatic, and a similar high asymptomatic positivity has also been reported. Generally, helminths do not induce long lasting immunity, therefore, maintenance of chronic low level (asymptomatic) infection is a better immune strategy against them. This leads to intermittent presence of parasites in stool and could be one of the reasons for the wide variation in results reported by various prevalence studies. In our study only 18 out of the 23 positive cases were detected by the examination of a single stool sample. Three were detected by the examination of a second sample and two in the third sample.
The finding of ascariasis as the most common helminthic infection and giardiasis the commonest protozoal infection, is in agreement with most of the previous studies. The prevalence of hookworm is usually low in urban slums as agricultural activity is required to maintain high levels of its transmission. Moreover, most of the subjects use footwear regularly, thus minimizing the chance for contact.
Albendazole and tinidazole proved to be successful in clearing intestinal parasites. Single dose treatments with drugs effective for Ascaris are known to be less effective for Trichuris. A second similar dose of albendazole cleared the infection.
Parasitic infections can cause a 10 to 100-fold elevation in total serum IgE. These infections not only stimulate the production of specific anti-parasite IgE but also nonspecifically induce polyclonal IgE synthesis. In our subject group, we observed a 20-fold elevation in total serum IgE level before treatment. Serum IgE has a short half-life of 2 to 5 days and in well-nourished subjects their levels fall considerably after antiparasitic therapy. However, there was no significant change in total serum IgE levels ten days after treatment in our subjects. This could be explained by their undernourished state. Sustained high levels of nonspecific IgE in serum can diminish specific IgE responses. Further, mast cell Fc epsilon receptors are saturated by polyclonal IgE, which inhibits allergic reactivity by rendering the individual susceptible to parasitic re-infection.
The coexistence of parasitic infections and adult undernutrition has functional, social and economic consequences on the community. Further studies with much larger sample size are needed to assess the real magnitude of the problem. Implementation of short term control measures like antimicrobial therapy complemented with long term strategies like clean drinking water, adequate sanitation and improvement in the nutritional status is urgently needed.
| ~ References|| |
|1.||Ramesh GN, Malla N, Raju GS, Sehgal R, Ganguly NK, Mahajan RC, Dilawari JB. Epidemiological study of parasitic infestations in lower socioeconomic group in Chandigarh (north India). Indian J Med Res 1991;93:47-50. |
|2.||Sen R. Pathogenic intestinal parasites and bacteria in slum dwellers in Calcutta. Indian J Med Res 1968;56:1371-1380. |
|3.||Shetty PS, Shetty N. Parasitic infection and chronic energy deficiency in adults. Parasitology 1993;107:S159-S167. |
|4.||Hagel I, Lynch NR, Di Prisco MC, Sanchez J, Perez M. Nutritional status and the IgE response against Ascaris lumbricoides in children from a tropical slum. Trans R Soc Trop Med Hyg 1995;89:562-565. |
|5.||James WPT, Ferro-Luzzi A, Waterlow JC. Definition of chronic energy deficiency in adults. Report of a working party of the IDECG. Eur J Clin Nutr 1988;42:969-981. |
|6.||Antihelminthics. In: Martindale. The Extra Pharmacopeia. 31st Ed. (The Royal Pharmaceutical Society, London.) 1996:03-127. |
|7.||Zaat JOM, Mank ThG, Assendelft WJJ. Drugs for treating giardiasis (Cochrane Review). In: The Cochrane Library, 3, 2001. Oxford: Update Software (www.cochrane.org). |
|8.||Koski KG, Scott ME. Gastrointestinal nematodes, nutrition and immunity: Breaking the negative spiral. Annu Rev Nutr 2001;21:297-321. |
|9.||Chandra RK. Nutrition immunity and infection: present knowledge and future directions. Lancet 1983;1:688-691. |
|10.||Keusch GT, Farthing MJG. Nutrition and infection. Ann Rev Nutr 1986;6:131-154. |
|11.||Hotez PJ. Hookworm Infections. In: Tropical Infectious Diseases Principles, Pathogens and Practice. Vol. 2, Guerrant RL, Walker DH, Weller PF. Eds. (Churchill Livingstone, Philadelphia, USA) 1999. |
|12.||Gilgen D, Mascie-Taylor CGN, Rosetta L. Intestinal helminthic infections, anaemia and labour productivity of female tea pluckers in Bangladesh. Trop Med Int Health 2001;6:449-457. |
|13.||Lynch NR, Hagel IA, Palenque ME, Di Prisco MC, Escudero JE, Corao LA, Sandia JA, Ferreira LJ, Botto C, Perez M, Le Souef PN. Relationship between helminthic infection and IgE response in atopic and nonatopic children in a tropical environment. J Allergy Clin Immunol 1998;101:217-221. |