Abstract
Worms have co-evolved with humans over millions of years. To survive, they manipulate host systems by modulating immune responses so that they cause (in the majority of hosts) relatively subtle harm. Anthelminthic treatment has been promoted as a measure for averting worm specific pathology and to mitigate subtle morbidities which may include effects on anaemia, growth, cognitive function and economic activity. With our changing environment marked by rapid population growth, urbanisation, better hygiene practices and anthelminthic treatment, there has been a decline in worm infections and other infectious diseases and a rise in non-communicable diseases such as allergy, diabetes and cardiovascular disease. This review reflects upon our age-old interaction with worms, and the broader ramifications of life without worms for vaccine responses and susceptibility to other infections, and for allergy-related and metabolic disease. We touch upon the controversy around the benefits of mass drug administration for the more-subtle morbidities that have been associated with worm infections and then focus our attention on broader, additional aspects of life without worms, which may be either beneficial or detrimental.
Highlights
Over a billion people are estimated to be infected with helminths, most living in areas of poverty.[1,2] Helminths have coexisted with mammals for millions of years
A Cochrane review notes that evidence is insufficient to recommend use of anthelminthic medication for pregnant women in the first trimester and administration of a single dose anthelminthic was not associated with any impact on maternal anaemia.[26]
Non-obese diabetic mice infected with H. polygyrus and Trichinella spiralis are protected against type-1 diabetes through the Th2-associated reduction of inflammatory autoimmune responses.[42]
Summary
Over a billion people are estimated to be infected with helminths, most living in areas of poverty.[1,2] Helminths have coexisted with mammals for millions of years. Their lifecycles have evolved to ensure their survival while minimising harm to the mammalian host. Soil transmitted helminths (STH) such as hookworm, Ascaris lumbricoides, Trichuris trichiura and Strongyloides stercoralis spend part of their lifecycle in soil and gain access to their human host through skin penetration or ingestion.
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