Mycobacterial Diseases
Open Access

Immunological Strain of Coinfections with Worms and Tuberculosis

Nemb Nutman^{* *}Correspondence: Nemb Nutman, Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa, Email:

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Description

The interplay between nutrition, helminth infection, and the immune response in individuals with Mycobacterium tuberculosis (M. tb) is a complex and significant area of study. Understanding these relationships is essential for developing comprehensive strategies to improve health outcomes in populations heavily burdened by Tuberculosis (TB) and helminth infections [1]. Nutrition plays a pivotal role in maintaining a robust immune system. Macronutrients, such as proteins and fats, and micronutrients, like vitamins A, C, D, and zinc, are essential for proper immune function. Malnutrition, whether due to inadequate calorie intake or specific nutrient deficiencies, weakens the immune system, making individuals more susceptible to infections, including TB [2]. In the context of M. tb infection, malnutrition impairs the body’s ability to mount an effective immune response. It reduces the production of essential cytokines, hampers the activation of macrophages, and diminishes the proliferation of T-cells all essential components of the immune system in combating TB [3]. This compromised immunity can lead to more severe disease progression and increased transmission.

Helminth infections and immune modulation

Helminths, or parasitic worms, are widespread in regions where TB is endemic. These infections, particularly by species such as Ascaris lumbricoides, Schistosoma spp., and hookworms, can have profound effects on the host’s immune system [4]. Helminths are known to skew the immune response towards a Th2-dominated profile, characterized by increased production of Interleukin-4 (IL-4), IL-5, and IL-13, while suppressing Th1 responses that are important for controlling M. tb [5]. This Th2 bias induced by helminth infections interferes with the host’s ability to control TB effectively. M. tuberculosis relies on a robust Th1 response, which includes the production of Interferon-gamma (IFN-γ) to activate macrophages for killing the bacteria [6]. The dampened Th1 response in helminth-infected individuals can lead to poor containment of the TB bacilli and exacerbation of the disease.

The nutritional-helminth-TB nexus

The triad of malnutrition, helminth infection, and TB creates a vicious cycle that disproportionately affects vulnerable populations. Malnutrition weakens the immune response, making individuals more susceptible to helminth infections and TB [7]. Simultaneously, helminth infections exacerbate malnutrition through mechanisms like nutrient malabsorption, loss of appetite, and intestinal blood loss. This nutritional depletion further compromises immunity, heightening susceptibility to M. tuberculosis and impairing the ability to recover from infection [8]. Moreover, the immune modulation caused by helminths complicates the body’s ability to respond to TB infection. Helminth-driven immune suppression can mask TB symptoms or lead to atypical presentations, delaying diagnosis and treatment [9]. Additionally, helminth infections may interfere with the efficacy of TB vaccines, such as Bacille Calmette Guerin (BCG), by altering the immune response post-vaccination [10]. Addressing the interplay between nutrition, helminth infections, and TB requires a multifaceted approach:

Nutritional support: Providing balanced diets rich in macronutrients and micronutrients is important for bolstering immune responses. Nutritional supplementation programs targeted at high-risk populations can help mitigate the effects of malnutrition.

Deworming programs: Regular deworming interventions in helminth-endemic areas can reduce the immunosuppressive effects of these infections, thereby improving the body’s ability to combat TB.

Integrated healthcare: Screening for malnutrition, helminth infections, and TB should be integrated into routine healthcare services. This approach ensures early detection and treatment of co-existing conditions.

Vaccination strategies: Enhancing the efficacy of TB vaccines in helminth-endemic regions may require co-administration of deworming treatments or novel vaccine formulations tailored to these populations.

Conclusion

The intricate interplay between nutrition, helminth infections, and TB underscores the importance of a holistic approach to disease prevention and management. By addressing malnutrition and helminth infections alongside TB, we can improve immune responses, reduce disease severity, and enhance treatment outcomes. Collaborative efforts across nutrition, infectious disease, and public health sectors are essential to breaking the cycle of poverty and ill-health perpetuated by these interconnected challenges.

References

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