title: Asymptomatic Helminth Infection in Active Tuberculosis Is Associated with Increased Regulatory and Th-2 Responses and a Lower Sputum Smear Positivity.
abstract: BACKGROUND
  The impact of intestinal helminth infection on the clinical presentation and immune response during active tuberculosis (TB) infection is not well characterized. Our aim was to investigate whether asymptomatic intestinal helminth infection alters the clinical signs and symptoms as well as the cell mediated immune responses in patients with active TB.
  
  
  METHODS
  Consecutive, newly diagnosed TB patients and healthy community controls (CCs) were recruited in North-west Ethiopia. TB-score, body mass index and stool samples were analyzed. Cells from HIV-negative TB patients (HIV-/TB) and from CCs were analyzed for regulatory T-cells (Tregs) and cytokine responses using flow cytometry and ELISPOT, respectively.
  
  
  RESULTS
  A significantly higher ratio of helminth co-infection was observed in TB patients without HIV (Helm+/HIV-/TB) compared to HIV negative CCs, (40% (121/306) versus 28% (85/306), p = 0.003). Helm+/HIV-/TB patients showed significantly increased IL-5 secreting cells compared to Helm-/HIV-/TB (37 SFU (IQR:13-103) versus 2 SFU (1-50); p = 0.02, n = 30). Likewise, levels of absolute Tregs (9.4 (3.2-16.7) cells/μl versus 2.4 (1.1-4.0) cells/μl; p = 0.041) and IL-10 secreting cells (65 SFU (7-196) versus 1 SFU (0-31); p = 0.014) were significantly higher in Helm+/HIV-/TB patients compared to Helm-/HIV-/TB patients. In a multivariate analysis, a lower rate of sputum smear positivity for acid fast bacilli, lower body temperature, and eosinophilia were independently associated with helminth infection in TB patients.
  
  
  CONCLUSIONS
  Asymptomatic helminth infection is associated with increased regulatory T-cell and Th2-type responses and a lower rate of sputum smear positivity. Further studies are warranted to investigate the clinical and immunological impact of helminth infection in TB patients.
authors.affiliation: Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia; Department of Medical Microbiology, Linköping University, Linköping, Sweden.
authors.forename: Ebba
authors.initials: E
authors.lastname: Abate
authors.affiliation: Department of Medical Laboratory Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Meseret
authors.initials: M
authors.lastname: Belayneh
authors.affiliation: Department of Anaesthesia and Intensive Care, Västervik Hospital, Västervik, Sweden.
authors.forename: Jonna
authors.initials: J
authors.lastname: Idh
authors.affiliation: Department of Internal Medicine, University of Gondar, Gondar, Ethiopia.
authors.forename: Ermias
authors.initials: E
authors.lastname: Diro
authors.affiliation: Department of cancer and inflammation, University of Southern Denmark, Odense, Denmark.
authors.forename: Daniel
authors.initials: D
authors.lastname: Elias
authors.affiliation: Department of Infectious diseases, Karolinska Hospital, Stockholm, Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Britton
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: Abraham
authors.initials: A
authors.lastname: Aseffa
authors.affiliation: Department of Medical Microbiology, Linköping University, Linköping, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Stendahl
authors.affiliation: Department of Medical Microbiology, Linköping University, Linköping, Sweden; Department of Clinical Microbiology and Infectious Diseases, Kalmar County Hospital, Kalmar, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schön
mesh_terms: D000293:Adolescent; D000328:Adult; D060085:Coinfection; D005243:Feces / Q000469:parasitology; D005260:Female; D006373:Helminthiasis / Q000150:complications*; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000150:complications / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D013183:Sputum / Q000382:microbiology*; D050378:T-Lymphocytes, Regulatory / Q000502:physiology*; D018418:Th2 Cells / Q000502:physiology*; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D055815:Young Adult