Helminths and malaria co-infections are associated with elevated serum IgE.

Andargachew Mulu,Beyene Moges,Yeshambel Belyhun,Fusao Ota,Techalew Shimelis,Berhanu Erko,Demise Nigussie,Daniel Elias,Mengistu Legesse,Afework Kassu

doi:10.1186/1756-3305-7-240

Abstract

BackgroundBoth helminth and malaria infections result in a highly polarized immune response characterized by IgE production. This study aimed to investigate the total serum IgE profile in vivo as a measure of Th2 immune response in malaria patients with and without helminth co-infection.MethodsA cross sectional observational study composed of microscopically confirmed malaria positive (N = 197) and malaria negative (N = 216) apparently healthy controls with and without helminth infection was conducted at Wondo Genet Health Center, Southern Ethiopia. A pre-designed structured format was utilized to collect socio-demographic and clinical data of the subjects. Detection and quantification of helminths, malaria parasites and determination of serum IgE levels were carried out following standard procedures.ResultsIrrespective of helminth infection, individuals infected by malaria showed significantly high levels of serum IgE compared with malaria free apparently healthy controls (with and without helminth infections). Moreover, malaria patients co-infected with intestinal helminths showed high level of serum IgE compared with those malaria patients without intestinal helminths (2198 IU/ml versus 1668 IU/ml). A strong statistically significant association was observed between malaria parasite density and elevated serum IgE levels (2047 IU/ml versus 1778 IU/ml; P = 0.001) with high and low parasitaemia (parasite density >50,000 parasite/μl of blood), respectively. Likewise, helminth egg loads were significantly associated with elevated serum IgE levels (P = 0.003).ConclusionsThe elevated serum IgE response in malaria patients irrespective of helminth infection and its correlation with malaria parasite density and helminth egg intensity support that malaria infection is also a strong driver of IgE production as compared to helminths.

Highlights

Both helminth and malaria infections result in a highly polarized immune response characterized by IgE production
A strong statistically significant association was observed between malaria parasite density and elevated serum IgE level (2047 IU/ml versus 1778 IU/ml; P = 0.001) for high and low parasitaemia, respectively
The highly elevated serum IgE level in malaria infected patients with helminth co-infection in the current study might be a result of both malaria and helminth induced immune dysregulation which induces a shift in cytokine production from Th1 to Th2 [32] and the resulting polyclonal activation of B cells in which the production of cytokines from Th2 cells increases synthesis of IgE

Summary

Introduction

Both helminth and malaria infections result in a highly polarized immune response characterized by IgE production. Helminthic infections are estimated to cause one million deaths per year and affect the health status of an individual on its physical, mental development and cause malnutrition, anaemia, In sub Saharan Africa, due to the high prevalence of helminthic infections, a dominant Th2 immune response has been suggested to increase susceptibility to malaria, M. tuberculosis and HIV [9] and to hasten progression of these diseases [6,10,11] Such an imbalance with an increase in Th2 cells favors IgE production [12], which may influence the clinical features of the disease. A recent study from malaria endemic areas of Gabon and India showed that circulating levels of total IgE do not appear to correlate with protection or pathology of malaria [17]

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