Dose-dependent impact of larval Ascaris suum on host body weight in the mouse model

Ascaris lumbricoides and Ascaris suum are important helminth parasites of humans and pigs, respectively. Although it is now well established that the presence of mature adult worms in the host intestine contributes to significant nutritional morbidity, the impact of larval migratory ascariasis is far less well understood. The development of a mouse model to explore susceptibility and resistance to larval ascariasis in the lungs provided an opportunity to observe the impact of larval migration on host growth during the course of infection. Changes in body weight were monitored in two strains of inbred mice, the susceptible C57BL/6j and the resistant CBA/Ca. Groups of mice received one of four doses: 100, 500, 1000 and 3000 fully embryonated A. suum ova. Infected mice underwent post-mortem on days 6, 7 and 8 post-infection. Control mice received a placebo dose of intubation medium and underwent post-mortem on day 7 post-infection. Mice were weighed pre-infection (day 0) and post-infection on the day of post-mortem. At post-mortem, the lungs of each mouse were removed for enumeration of Ascaris larval burdens by means of the modified Baermann method. Control mice of each strain showed an increase in weight from preinfection to post-infection day. Within the C57BL/6j strain, mice infected with higher doses of Ascaris eggs experienced a reduction in body weight; for those given 3000 eggs this was on all three post-mortem days, and for those given 1000, on days 7 and 8. For CBA/Ca mice, only mice receiving the 3000 dose demonstrated a reduction in body weight. These findings suggest that larval migratory ascariasis has a significant negative impact upon host growth and that this is related to infective dose and larval burden

Natural immunity to Ascaris lumbricoides associated with immunoglobulin E antibody to ABA-1 allergen and inflammation indicators in children, Infect. Immun. 67

Children putatively immune to the large roundworm Ascaris lumbricoides were identified in an area of Nigeria where infection is hyperendemic. Immunity was associated with higher levels of serum ferritin, C-reactive protein, and eosinophil cationic protein, indicating ongoing acute phase or inflammatory processes. In contrast, children who were susceptible to the infection had little serological evidence of inflammation despite their high parasite burdens. Immunoglobulin G (IgG) antibody activity in all subclasses was present in high titer in most children but appeared to have no protective function. Despite exceptionally high total IgE levels, there was no evidence that atopic responses to local common allergens was associated with natural immunity to Ascaris. Among those individuals who produced IgG antibody to recombinant ABA-1 allergen of Ascaris, the naturally immune group had significantly more IgE antibody to the allergen than did those susceptible to the infection. IgE antibody responses in conjunction with innate inflammatory processes therefore appear to associate with natural immunity to ascariasis. Helminth parasites are renowned for inducing elevated levels of serum immunoglobulin E (IgE) (20, 33), but the protective role of the antibody component of this response remains debatable The large roundworm of humans, Ascaris lumbricoides, inhabits the intestine, but juvenile-stage worms undergo a tissuemigratory phase involving the liver and lungs before returning to the intestine, where they mature to large adult worms. The pulmonary phase can cause potentially lethal hypersensitivity responses in infected individuals, particularly children, and worm material is notorious for the allergic reactions that it provokes in laboratory workers (33). A. lumbricoides infects a quarter of humanity and people can remain infected for much of their lives, although at the population level, intensity of infection decreases with age after a peak within the first decade of life in high-intensity areas We have examined a range of serum factors in African children living in an area highly endemic for A. lumbricoides, using the number of worms developing to maturity as a measure of immunity status. Quantifying worm burden is superior to using the number of eggs released, because egg production is a poor indicator of the number of adult worms present (15, 18) and may miss low-level infections. The children were examined for infection on two separate occasions, and those either consistently infected or putatively immune were identified. Neither the mechanisms by which immunity to A. lumbricoides operates nor the site within the body at which it is manifest is known. Therefore, in addition to measuring of antibody in the different isotypes, we examined a range of serological markers for inflammatory responses to provide an indication of the pathological processes which might accompany immune killing of the parasites. We find that natural immunity to Ascaris is associated with IgE antibody to a major allergen of the parasite and a serum protein profile consistent with ongoing inflammatory processes. MATERIALS AND METHODS Study population. The study site was in an area of Nigeria (Ile-Ife) in which more than 80% of the school children (5 to 15 years old) were infected with intestinal nematodes, particularly A. lumbricoides (for full details, see reference 18). A group of children were treated for their intestinal nematode infections, and their worm burdens were collected and counted over a 48-h period after anthelminthic treatment (phase 1). The anthelminthic used was Ketrax (levamisole; ICI Pharmaceuticals, Macclesfield, United Kingdom), and children were given the appropriate dosage according to the manufacturer's instructions. The exercise was repeated 6 months later (phase 2), at which time blood samples were collected from 92 of the children. The children were classified as follows: category 1, those with no worms on either of the two occasions (putatively immune); category 2, those with consistently light infections (1 to 24 worms in phase 1 and 1 to 8 worms in phase 2); or category 3, those who were consistently heavily infected or susceptible, i.e., had more than the population mean plus 1 standard deviation worm burden on both occasions. The means Ϯ standard deviations of the worm burdens in phases 1 and 2 were 11.02 Ϯ 13.7 and 3.5 Ϯ 5.6, respectively. Category 3 comprised children with worm counts of Ն25 after the first treatment and Ն9 after the second treatment. There were 22, 47, and 23 children in categories 1, 2, and 3, respectively. None of the children showed overt signs o

An investigation of Mycobacterium bovis and helminth coinfection in the European badger Meles meles

We investigated the relationship between the presence of helminth parasites in European badgers, and their tuberculosis (TB) status, culled as part of the bovine TB eradication programme in Ireland. Data on the worm burden or faecal egg or larval count was available for all helminth taxa recorded. Lymph node tissue samples were taken from the badgers and tested for TB. We then explored the correlation, in full-grown badgers, between the likelihood of M. bovis infection and both the prevalence and burden of certain helminth species. Specifically, our analyses focused upon the gastrointestinal species, Uncinaria criniformis and Strongyloides spp. We found that male badgers were more likely to have TB than female badgers, and that badgers infected with U. criniformis or Strongyloides spp. were more likely to have TB than badgers without such helminth infections. There was a suggestion that badgers with higher U. criniformis worm burdens were more likely to have TB than those with lesser burdens. Although our sampling protocols did not allow us to determine which infection came first, it strongly suggests that once badgers are infected with either gastrointestinal helminths or TB, they are likely to become coinfected. As Ireland works towards a national TB-free status, it will be important to appreciate the implications of such coinfection

Patterns of soil-transmitted helminth infection and impact of four-monthly albendazole treatments in preschool children from semi-urban communities in Nigeria: a double-blind placebo-controlled randomised trial

Background Children aged between one and five years are particularly vulnerable to disease caused by soil-transmitted helminths (STH). Periodic deworming has been shown to improve growth, micronutrient status (iron and vitamin A), and motor and language development in preschool children and justifies the inclusion of this age group in deworming programmes. Our objectives were to describe the prevalence and intensity of STH infection and to investigate the effectiveness of repeated four-monthly albendazole treatments on STH infection in children aged one to four years. Methods The study was carried out in four semi-urban villages situated near Ile-Ife, Osun State, Nigeria. The study was a double-blind placebo-controlled randomised trial. Children aged one to four years were randomly assigned to receive either albendazole or placebo every four months for 12 months with a follow-up at 14 months. Results The results presented here revealed that 50% of the preschool children in these semi-urban communities were infected by one or more helminths, the most prevalent STH being Ascaris lumbricoides (47.6%). Our study demonstrated that repeated four-monthly anthelminthic treatments with albendazole were successful in reducing prevalence and intensity of A. lumbricoides infections. At the end of the follow-up period, 12% and 43% of the children were infected with A. lumbricoides and mean epg was 117 (S.E. 50) and 1740 (S.E. 291) in the treatment and placebo groups respectively compared to 45% and 45% of the children being infected with Ascaris and mean epg being 1095 (S.E. 237) and 1126 (S.E. 182) in the treatment and placebo group respectively at baseline. Conclusion Results from this study show that the moderate prevalence and low intensity of STH infection in these preschool children necessitates systematic treatment of the children in child health programmes

Impact of repeated four-monthly anthelmintic treatment on Plasmodium infection in preschool children: a double-blind placebo-controlled randomized trial

<p>Abstract</p> <p>Background</p> <p>Helminth infections can alter susceptibility to malaria. Studies need to determine whether or not deworming programs can impact on <it>Plasmodium </it>infections in preschool children.</p> <p>Methods</p> <p>A double-blind placebo-controlled randomised trial was conducted to investigate the impact of anthelmintic treatment on <it>Plasmodium </it>infection in children aged 12-59 months. Children were randomly assigned to receive either albendazole or placebo every four months for 12 months with a follow-up at 14 months.</p> <p>Results</p> <p>320 children (out of 1228, 26.1%) complied with all the follow-up assessments. <it>Plasmodium </it>prevalence and mean <it>Plasmodium </it>parasite density was significantly higher in the treatment group (44.9% and 2319 ± SE 511) compared to the placebo group (33.3% and 1471 ± 341) at baseline. The odds of having <it>Plasmodium </it>infection increased over time for children in both the placebo and treatment groups, however this increase was significantly slower for children in the treatment group (P = 0.002). By month 14, mean <it>Plasmodium </it>density had increased by 156% in the placebo group and 98% in the treatment group but the rate of change in <it>Plasmodium </it>density was not significantly different between the groups. The change from baseline in haemoglobin had a steeper increase among children in the treatment group when compared to the placebo group but this was not statistically significant.</p> <p>Conclusions</p> <p>Repeated four-monthly anthelminthic treatments for 14 months resulted in a significantly lower increase in the prevalence of <it>Plasmodium </it>infection in preschool children which coincided with a reduction in both the prevalence and intensity of <it>A. lumbricoides </it>infections.</p> <p>Trial Registration</p> <p>Current controlled trials ISRCTN44215995</p

Counteracting Quasispecies Adaptability: Extinction of a Ribavirin-Resistant Virus Mutant by an Alternative Mutagenic Treatment

[Background] Lethal mutagenesis, or virus extinction promoted by mutagen-induced elevation of mutation rates of viruses, may meet with the problem of selection of mutagen-resistant variants, as extensively documented for standard, nonmutagenic antiviral inhibitors. Previously, we characterized a mutant of foot-and-mouth disease virus that included in its RNA-dependent RNA polymerase replacement M296I that decreased the sensitivity of the virus to the mutagenic nucleoside analogue ribavirin.[Methodology and Principal Findings] Replacement M296I in the viral polymerase impedes the extinction of the mutant foot-and-mouth disease virus by elevated concentrations of ribavirin. In contrast, wild type virus was extinguished by the same ribavirin treatment and, interestingly, no mutants resistant to ribavirin were selected from the wild type populations. Decreases of infectivity and viral load of the ribavirin-resistant M296I mutant were attained with a combination of the mutagen 5-fluorouracil and the non-mutagenic inhibitor guanidine hydrocloride. However, extinction was achieved with a sequential treatment, first with ribavirin, and then with a minimal dose of 5-fluorouracil in combination with guanidine hydrochloride. Both, wild type and ribavirin-resistant mutant M296I exhibited equal sensitivity to this combination, indicating that replacement M296I in the polymerase did not confer a significant cross-resistance to 5-fluorouracil. We discuss these results in relation to antiviral designs based on lethal mutagenesis[Conclusions] (i) When dominant in the population, a mutation that confers partial resistance to a mutagenic agent can jeopardize virus extinction by elevated doses of the same mutagen. (ii) A wild type virus, subjected to identical high mutagenic treatment, need not select a mutagen-resistant variant, and the population can be extinguished. (iii) Extinction of the mutagen-resistant variant can be achieved by a sequential treatment of a high dose of the same mutagen, followed by a combination of another mutagen with an antiviral inhibitor.Work supported by grants BFU2005-00863, BFU2008-02816/BMC, Proyecto Intramural de Frontera del CSIC 200820FO191, FIPSE 36558/06, and Fundacio´n Ramo´n Areces. CIBERehd is funded by Instituto de Salud Carlos III. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscriptPeer reviewe

Evaluating the Benefits of Aphasia Intervention Delivered in Virtual Reality: Results of a Quasi-Randomised Study

Introduction This study evaluated an intervention for people with aphasia delivered in a novel virtual reality platform called EVA Park. EVA Park contains a number of functional and fantastic locations and allows for interactive communication between multiple users. Twenty people with aphasia had 5 weeks’ intervention, during which they received daily language stimulation sessions in EVA Park from a support worker. The study employed a quasi randomised design, which compared a group that received immediate intervention with a waitlist control group. Outcome measures explored the effects of intervention on communication and language skills, communicative confidence and feelings of social isolation. Compliance with the intervention was also explored through attrition and usage data. Results There was excellent compliance with the intervention, with no participants lost to follow up and most (18/20) receiving at least 88% of the intended treatment dose. Intervention brought about significant gains on a measure of functional communication. Gains were achieved by both groups of participants, once intervention was received, and were well maintained. Changes on the measures of communicative confidence and feelings of social isolation were not achieved. Results are discussed with reference to previous aphasia therapy findings

Potential Benefits of Sequential Inhibitor-Mutagen Treatments of RNA Virus Infections

Lethal mutagenesis is an antiviral strategy consisting of virus extinction associated with enhanced mutagenesis. The use of non-mutagenic antiviral inhibitors has faced the problem of selection of inhibitor-resistant virus mutants. Quasispecies dynamics predicts, and clinical results have confirmed, that combination therapy has an advantage over monotherapy to delay or prevent selection of inhibitor-escape mutants. Using ribavirin-mediated mutagenesis of foot-and-mouth disease virus (FMDV), here we show that, contrary to expectations, sequential administration of the antiviral inhibitor guanidine (GU) first, followed by ribavirin, is more effective than combination therapy with the two drugs, or than either drug used individually. Coelectroporation experiments suggest that limited inhibition of replication of interfering mutants by GU may contribute to the benefits of the sequential treatment. In lethal mutagenesis, a sequential inhibitor-mutagen treatment can be more effective than the corresponding combination treatment to drive a virus towards extinction. Such an advantage is also supported by a theoretical model for the evolution of a viral population under the action of increased mutagenesis in the presence of an inhibitor of viral replication. The model suggests that benefits of the sequential treatment are due to the involvement of a mutagenic agent, and to competition for susceptible cells exerted by the mutant spectrum. The results may impact lethal mutagenesis-based protocols, as well as current antiviral therapies involving ribavirin

Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study

<p>Abstract</p> <p>Background</p> <p>Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows.</p> <p>Methods</p> <p>Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex.</p> <p>Results</p> <p>Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1^st(7.4 μg/m³) to the 25^th(17.2 μg/m³), 50^th(33.8 μg/m³), 75^th(108.3 μg/m³), and 90^th(180.8 μg/m³) percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05), 62 g (1.63), 98 g (2.26) and 109 g (2.44) respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage.</p> <p>Conclusions</p> <p>The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing evidence of the harmful effects of air pollution on birth outcomes.</p

Man and his parasites: Integration of biomedical and social approaches to transmission and control

The significance of sociocultural and behavioural factors in the transmission and control of parasitic infections has been underestimated. Explanations for this neglect include the failure of communication between biomedics and social scientists and reliance on control measures such as mass chemotherapeutic and anti-vector programmes which do not involve the participation of the community at risk. The need for an integrated approach to both the impact of parasitic infections and their control is now being recognised. Given their very high prevalence and the background socio-economic and other factors which exacerbate the problem, parasites of the subtropical countries will be the main emphasis of this discussion. The paper will illustrate a number of methodologies employed to look at the relationship between sociocultural and parasitic infections rather than provide a catalogue of interesting and yet isolated examples of human risk behaviours. These methodologies will include assessments of both individual risk factors and a broader framework to include larger social groupings including 'outsiders' involved in control programmes. Finally, the importance of this type of emphasis within control strategies will be discussed and a concluding section on research priorities and recommendations will be presented.parasite transmission control human behaviour culture