Abstract
BackgroundInfections with soil-transmitted helminths (STHs) may result in chronic inflammatory disorders affecting the human host. The objective of this study was to evaluate Fecal Calprotectin (FC) and Fecal Occult Blood (FOB) in individuals infected and non-infected with STHs to identify potential intestinal morbidity markers.MethodsStool from participants diagnosed positive for Trichuris trichiura and concomitant STH infections from three countries was used to perform FC and FOB point-of-care assays. Simultaneously, identified STH negative participants underwent FC and FOB testing as controls. Potential associations between test results and determinants were analyzed using multivariable logistic regression.FindingsIn total, 1034 T. trichiura infected cases (mostly light infections) and 157 STH negative controls were tested for FC and FOB. Among all participants tested, 18·5% had ≥ 50 µg/g FC concentration, while 14 (1·2%) were positive for FOB. No statistically significant association was found between T. trichiura infection or Ascaris lumbricoides co-infection and FC concentration, while an inverse association (odds ratio (OR): 0·45, 95% credible intervals (CrI): 0·26, 0·75) was found between hookworm co-infection and FC concentration. In Lao PDR, the proportion of participants in the ≥ 50 µg/g FC category was significantly higher in the oldest age category compared to the 5–11 years group (OR: 3·31, 95% CrI: 1·62, 7·24). Too few participants were found positive for FOB to derive any conclusions.InterpretationStudies are needed to better understand the relationship between intestinal morbidity and STH infections. Suitable, standardized, low-cost markers of STH attributable morbidity to better monitor the impact of STH control interventions are necessary.FundingBMGF (OPP1153928)
Highlights
More than 1¢5 billion people worldwide are infected with soil-transmitted helminths (STHs), namely Ascaris lumbricoides, hookwormResearch in contextEvidence before this studyLong-term infections with soil-transmitted helminths (STHs) contribute to substantial morbidity; evidence on appropriate point-of-care indicators of STH attributable morbidity is scarce
We applied Fecal Calprotectin (FC) and Fecal Occult Blood (FOB) tests to assess the relationship between STH infections and intestinal inflammation or mucosal bleeding in three different countries
We found no associations of FC and FOB with T. trichiura infection and A. lumbricoides co-infection status and intensity in each of the three settings tested, demonstrating that FC and FOB are not good proxy markers for STH attributable gut morbidity
Summary
More than 1¢5 billion people worldwide are infected with soil-transmitted helminths (STHs), namely Ascaris lumbricoides, hookwormResearch in contextEvidence before this studyLong-term infections with soil-transmitted helminths (STHs) contribute to substantial morbidity; evidence on appropriate point-of-care indicators of STH attributable morbidity is scarce. Contradictory findings result from a small body of evidence (nine studies) on the association between STH infection status, infection intensity and intestinal morbidity, using Fecal Calprotectin (FC) or Fecal Occult Blood (FOB) as indicators. This is the first large scale study testing FC and FOB as potential proxy markers for STH attributable intestinal morbidity in three different countries. No association between the presence of intestinal inflammation or mucosal bleeding, assessed with FC and FOB, and T. trichiura and A. lumbricoides infection status was found, while a negative association between FC concentration and hookworm infection was found. The objective of this study was to evaluate Fecal Calprotectin (FC) and Fecal Occult Blood (FOB) in individuals infected and non-infected with STHs to identify potential intestinal morbidity markers.
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