Maternal transmission of asexually proliferative Mesocestoides corti tetrathyridia (Cestoda) in mice

Asexually proliferative Mesocestoides corti tetrathyridia were studied to test the hypothesis of in utero transmission in mice and define more clearly the path of transmammary transmission. In utero transmission was not observed in 132 fetuses (22 litters) taken by caesarean section from infected mothers. However, 19 of these mothers had tetrathyridia in their mammary glands at the time of operation, nine had worms in the uterine lumen, and one had a single worm in the maternal blood space of a placenta. No tetrathyridia were found in amniotic cavities. No infection was found in 32 young (7 litters) examined immediately after birth to infected mothers, but before nursing. No infection was found in 30 young (5 litters) removed from infected mothers before nursing and raised by uninfected fosters. Of 29 uninfected young (5 litters) allowed to nurse on infected mothers, 18 became infected. Whole mounts and sections of infected mammary glands showed proliferating tetrathyridia free in larger milk ducts and free and encapsulated in mammary parenchyma. These data suggest that maternal transmission of M. corti tetrathyridia in mice occurs primarily or perhaps exclusively by the transmammary route.     

Developmental arrest and pregnancy-induced transmammary transmission of Ancylostoma caninum larvae in the murine model

Pregnancy is associated with reactivation of latent infections of many protozoal and helminthic parasites. To facilitate in vivo studies on the process of transmammary transmission of hookworm infection to nursing newborns, we established an experimental model of infection of BALB/c mice with infective larvae of the canine nematode Ancylostoma caninum. To establish latency with a significant reservoir of tissue larvae and achieve acceptable pregnancy success rates, mice were subcutaneously infected at day 5 postimpregnation; similar larval distribution profiles were observed at the end of the gestational period for bred compared to correspondingly infected unbred animals. No larvae were detected in fetuses or neonatal pups. Significant numbers of larvae were not detected in mammary tissue during the periparturient or postpartum lactational periods although about 8% of a dam's reservoir of tissue larvae was transferred to her nursing pups; this suggests that larvae reaching the mammary glands are rapidly transmitted through the milk sinuses, as was documented by histopathological analyses. Comparison of BALB/c with C57BL/6 mice that typically display divergent immune responses to infection showed no difference in tissue larval burden or in numbers transferred to pups. A hypothesis for the molecular mechanism of larval reactivation and transmission is discussed.     

Comparative biology of Uncinaria spp. in the California sea lion (Zalophus californianus) and the northern fur seal (Callorhinus ursinus) in California

Studies on several aspects of the life cycle of hookworms (Uncinaria spp.) in the California sea lion (Zalophus californianus) and northern fur seal (Callorhinus ursinus) were conducted on material collected on San Miguel Island (SMI), California and at The Marine Mammal Center, Sausalito, California in 1997, 1998, and 1999. Examination of Z. californianus intestines for adult hookworms and feces for eggs revealed that longevity of these parasites in pups is about 6-8 mo, and infections are probably not present in older sea lions. Parasitic third-stage larvae (L3) were recovered from the ventral abdominal tissue of Z. californianus, suggesting transmammary transmission. Callorhinus ursinus pups had no hookworm eggs in their feces or adult worms (except for 1 probable contaminant) in their intestines in the fall and early winter, revealing that adult Uncinaria spp. are spontaneously lost at <3 mo of age of the pups. Sand samples from rookeries, used by both Z. californianus and C. ursinus, on SMI were negative for free-living, L3 in summer months but positive in fall and winter months, indicating seasonality occurred.     

Intestinal parasites in southeast Asian refugees two years after immigration.

We collected stool specimens from 2,520 Southeast Asian refugees who had resided in the United States for an average of 2.1 years. More than half reported receiving prior treatment of parasites. At least one parasite was discovered in 32%, and multiple parasites were found in 8% of patients. Hookworm, Giardia, Strongyloides, and Hymenolepis nana were most commonly found. In comparison to studies done at the time of immigration, all parasites had decreased in frequency, but Giardia, hookworm, and H nana remain common. Although initial screening efforts may have failed to identify substantial numbers of infected refugees, poor compliance with treatment may also explain the persistence of intestinal parasites in our patients. The continued presence of Giardia and H nana, especially among children, may be explained by person-to-person transmission or autoinfection.     

Vertical transmission of helminths: Hypobiosis and amphiparatenesis

Vertical transmission has evolved in at least five lines of helminths and involves prenatal or, more commonly, transmammary pathways to the offspring. In this article, vertical transmission, hypobiosis and paratenesis are combined in a strategy for transmission called amphiparatenesis. Although many believe that vertical transmission of parasites is rare, Wesley Shoop suggests that it is not only significant in the evolution of certain helminths but it may have been one of the pivotal adaptations in the evolution of the eukaryotes and is essential in their continued existence.     

'Intervening is representing': medical campaigns that helped identify the prevalence of hookworm

This paper compares anti-hookworm campaigns conducted in the early twentieth century in France, Germany, Brazil and West India. The populations that suffer from hookworm are not identical in the North and in the South. In tropical and semi-tropical regions hookworm is mainly found among poor peasants and is related to lack of hygiene, while in temperate climates hookworm was a professional disease of miners, a highly organized professional segment. Nevertheless, major disparities in the pattern of hookworm control did not reflect the North-South divide, but a difference between campaigns. These aimed at the eradication of hookworm infection (Germany and West-India) and at alleviating the effects of this infection on populations (France and Brazil). Maps that represented the prevalence of hookworm mirrored the aims of the sanitary campaign in which they were used: eradication of parasitic worms versus the reduction of the handicap induced by these worms. In public health as well, representing is intervening. And vice versa: patterns of intervention shape representations.     

Necator americanus and helminth co-infections: further down-modulation of hookworm-specific type 1 immune responses

Background

Helminth co-infection in humans is common in tropical regions of the world where transmission of soil-transmitted helminths such as Ascaris lumbricoides, Trichuris trichiura, and the hookworms Necator americanus and Ancylostoma duodenale as well as other helminths such as Schistosoma mansoni often occur simultaneously.

Methodology

We investigated whether co-infection with another helminth(s) altered the human immune response to crude antigen extracts from either different stages of N. americanus infection (infective third stage or adult) or different crude antigen extract preparations (adult somatic and adult excretory/secretory). Using these antigens, we compared the cellular and humoral immune responses of individuals mono-infected with hookworm (N. americanus) and individuals co-infected with hookworm and other helminth infections, namely co-infection with either A. lumbricoides, Schistosoma mansoni, or both. Immunological variables were compared between hookworm infection group (mono- versus co-infected) by bootstrap, and principal component analysis (PCA) was used as a data reduction method.

Conclusions

Contrary to several animal studies of helminth co-infection, we found that co-infected individuals had a further downmodulated Th1 cytokine response (e.g., reduced INF-γ), accompanied by a significant increase in the hookworm-specific humoral immune response (e.g. higher levels of IgE or IgG4 to crude antigen extracts) compared with mono- infected individuals. Neither of these changes was associated with a reduction of hookworm infection intensity in helminth co-infected individuals. From the standpoint of hookworm vaccine development, these results are relevant; i.e., the specific immune response to hookworm vaccine antigens might be altered by infection with another helminth.     

Fatal experimental transplacental Babesia gibsoni infections in dogs

A Babesia gibsoni infected bitch was mated with an uninfected dog in order to determine whether this parasite could be vertically transmitted. The bitch delivered a litter of four live and one stillborn pup. The four pups died from congenital babesiosis between 14 and 39 days post-birth. Babesia gibsoni DNA was detected in tissue from all five pups. These results show that vertical transmission occurred by the uterine route and not via the transmammary route. This is the first confirmed report of transplacental Babesia infection in any animal species.     

Impact of maternal stress on the transmammary transfer and protective capacity of herpes simplex virus-specific immunity

In adults, psychological stress regulates immune responsiveness in part via the increased levels of corticosterone that are produced as a result of hypothalamic-pituitary-adrenal (HPA) axis activation. However, there is a lack of knowledge as to the role such regulation may play in the neonate. Neonates are severely compromised in their ability to generate an immune response to pathogens encountered after birth and therefore rely heavily on maternally derived antibody acquired postnatally through the milk. This passive transfer of antibody is critical for protection of the neonate from severe herpes simplex virus (HSV) infection and mortality. Using a well-established postnatal restraint/light stress model, we determined whether maternal stress and the associated increases in corticosterone would affect the transmammary transfer of antibody and subsequent neonate susceptibility to HSV-associated mortality. Serum corticosterone levels were markedly increased in lactating mice subjected to the restraint/light stress, and increased levels of corticosterone were transferred through the milk of these stressed mothers to their neonates. Despite these increases in corticosterone, the transmammary transfer and accumulation of total and HSV-specific IgG in neonate serum remained intact. This milk-derived, HSV-specific antibody alone protected the neonate from systemic viral spread. Interestingly, postnatal maternal stress significantly increased neonate survival after HSV-2 infection despite no apparent alteration in viral spread. These studies demonstrate that although the transmammary transfer of antibody is unaffected by maternal stress, stress may be enhancing components of antiviral immunity that are effective in protecting neonates from HSV-associated mortality.     

In vitro reactivation of Ancylostoma caninum tissue-arrested third-stage larvae by transforming growth factor-beta

Developmental arrest in Ancylostoma caninum is associated with preparasitic, free-living third-stage (L3) larvae, as well as anthelmintic-resilient hypobiotic L3 larvae within the tissues of an infected dog. With the tissue-arrested larvae, pregnancy and, more specifically, the hormonal effects of estrogen and prolactin mediate reactivation resulting in transmammary transmission of infection to nursing puppies. Estrogen and prolactin have been shown to be critically involved in upregulation of transforming growth factor (TGF)-beta2 during pregnancy, and studies on the soil nematode Caenorhabditis elegans further implicate TGF-beta and insulin-like signaling pathways with larval arrest and reactivation. In this report, an in vitro assay was used to show that neither estrogen, prolactin, nor insulin had a direct effect on the feeding/reactivation response of tissue-arrested larvae; however, TGF-beta isoforms 1 and 2 both had significant stimulatory effects that were comparable to the effects of dog serum. The stimulatory effects of serum could be blocked by preincubation with anti-TGF-beta antibodies. Taken together, the results support the hypothesis that during pregnancy, host-derived TGF-beta can signal a parasite-encoded receptor to trigger the reactivation of tissue-arrested larvae. TGF-beta had no effect on preparasitic larvae, suggesting that different signals may be involved in reactivation of the 2 different arrested forms of A. caninum L3 larvae.     

X-ray structure of Na-ASP-2, a pathogenesis-related-1 protein from the nematode parasite, Necator americanus, and a vaccine antigen for human hookworm infection

Human hookworm infection is a major cause of anemia and malnutrition of adults and children in the developing world. As part of on-going efforts to control hookworm infection, The Human Hookworm Vaccine Initiative has identified candidate vaccine antigens from the infective L3 larval stages of the parasite, including a family of pathogenesis-related (PR) proteins known as the Ancylostoma-secreted proteins (ASPs). A novel crystal structure of Na-ASP-2, a PR-1 protein secreted by infective larvae of the human hookworm Necator americanus, has been solved to resolution limits of 1.68 A and to an R-factor of 17% using the recombinant protein expressed in and secreted by Pichia pastoris. The overall fold of Na-ASP-2 is a three-layer alphabetaalpha sandwich flanked by an N-terminal loop and a short, cysteine-rich C terminus. Our structure reveals a large central cavity that is flanked by His129 and Glu106, two residues that are well conserved in all parasitic nematode L3 ASPs. Na-ASP-2 has structural and charge similarities to chemokines, which suggests that Na-ASP-2 may be an extra-cellular ligand of an unknown receptor. Na-ASP-2 is a useful homology model for NIF, a natural antagonistic ligand of CR3 receptor. From these modeling studies, possible binding modes were predicted. In addition, this first structure of a PR-1 protein from parasitic helminths may shed light on the molecular basis of host-parasite interactions.     

Regional,Household and Individual Factors that Influence Soil Transmitted Helminth Reinfection Dynamics in Preschool Children from Rural Indigenous Panamá

Background

Few studies have investigated the relative influence of individual susceptibility versus household exposure factors versus regional clustering of infection on soil transmitted helminth (STH) transmission. The present study examined reinfection dynamics and spatial clustering of Ascaris lumbricoides, Trichuris trichiura and hookworm in an extremely impoverished indigenous setting in rural Panamá over a 16 month period that included two treatment and reinfection cycles in preschool children.

Methodology/Principle Findings

Spatial cluster analyses were used to identify high prevalence clusters for each nematode. Multivariate models were then used (1) to identify factors that differentiated households within and outside the cluster, and (2) to examine the relative contribution of regional (presence in a high prevalence cluster), household (household density, asset-based household wealth, household crowding, maternal education) and individual (age, sex, pre-treatment eggs per gram (epg) feces, height-for-age, latrine use) factors on preschool child reinfection epgs for each STH. High prevalence spatial clusters were detected for Trichuris and hookworm but not for Ascaris. These clusters were characterized by low household density and low household wealth indices (HWI). Reinfection epg of both hookworm and Ascaris was positively associated with pre-treatment epg and was higher in stunted children. Additional individual (latrine use) as well as household variables (HWI, maternal education) entered the reinfection models for Ascaris but not for hookworm.

Conclusions/Significance

Even within the context of extreme poverty in this remote rural setting, the distinct transmission patterns for hookworm, Trichuris and Ascaris highlight the need for multi-pronged intervention strategies. In addition to poverty reduction, improved sanitation and attention to chronic malnutrition will be key to reducing Ascaris and hookworm transmission.     

Suppression of inflammatory immune responses in celiac disease by experimental hookworm infection

We present immunological data from two clinical trials where the effect of experimental human hookworm (Necator americanus) infection on the pathology of celiac disease was evaluated. We found that basal production of Interferon- (IFN-)γ and Interleukin- (IL-)17A from duodenal biopsy culture was suppressed in hookworm-infected participants compared to uninfected controls. Increased levels of CD4+CD25+Foxp3+ cells in the circulation and mucosa are associated with active celiac disease. We show that this accumulation also occurs during a short-term (1 week) oral gluten challenge, and that hookworm infection suppressed the increase of circulating CD4+CD25+Foxp3+ cells during this challenge period. When duodenal biopsies from hookworm-infected participants were restimulated with the immunodominant gliadin peptide QE65, robust production of IL-2, IFN-γ and IL-17A was detected, even prior to gluten challenge while participants were strictly adhering to a gluten-free diet. Intriguingly, IL-5 was produced only after hookworm infection in response to QE65. Thus we hypothesise that hookworm-induced TH2 and IL-10 cross-regulation of the TH1/TH17 inflammatory response may be responsible for the suppression of these responses during experimental hookworm infection.     

Do hookworms elicit protective immunity in man?

The two main species of human hookworm, Ancylostoma duodenale and Necator americanus (Table 1), are together believed to infect about 900 million people - mainly in tropical countries where adequate sanitary facilities may be lacking. But interactions between the two species, and their relative contributions to observed age-related infection patterns and seasonal cycles of transmission, continue to engender controversy. People tend to remain susceptible to infection through-out life, even with constant exposure to the infective stages. So what role does human immunity or resistance play in the epidemiology and control of infection? In this article, Jerzy Behnke reviews the epidemiology of hookworm infection in the light of current understanding of mechanisms involved in host responses to infection and hookworm evasion of those responses. As he stresses, much further work is required.     

Antagonism between two intestinal parasites in humans: the importance of co-infection for infection risk and recovery dynamics

Co-infection may affect transmission and recovery from infection, but remains an understudied element of disease ecology, particularly with regard to antagonism between parasites sharing a host. Helminth and giardia infections are often endemic in the same populations and both occupy the small intestine; yet few studies have examined interactions between these parasites. We report on helminth–giardia co-infections in a panel study of forager–horticulturalists in the Bolivian lowlands. Parasites were identified in faecal samples from 3275 participants, collected during 5235 medical exams over 6 years. Longitudinal co-infection patterns were examined using logistic mixed and multi-state Markov models. The most prevalent infections were hookworm (56%), Giardia lamblia (30%) and Ascaris lumbricoides (15%). Cross-sectionally, hookworm and A. lumbricoides were negatively associated with G. lamblia (OR = 0.60; OR = 0.65, respectively). Longitudinally, giardia infection was less likely in helminth-infected individuals (HR: 0.46). Infection with helminths was also less likely for individuals infected with giardia (HR: 0.71). Finally, treatment with mebendazole reduced subsequent hookworm infections, but resulted in a marginal increase in the odds of G. lamblia infection. Our results provide evidence for an antagonistic relationship between helminths and giardia, and suggest that co-infection should be considered in disease transmission models and treatment decisions.     

Antiepidemic measures against ancylostomiasis and their efficiency in our conditions

Coprological examinations were made in 358 foreigners, 51 of which (14.2%) were positive from the point of view of hookworm eggs presence. On the basis of the discovered infection prevalence, which is still high in foreigners arriving to the CSSR from the tropics and subtropics and on the basis of the new information about the developmental cycle of Ancylostoma duodenale the author recommends to alter the so far valid antiepidemic measures in the following sense: Persons should be regarded as parasitologically negative to hookworm infection, if their coprological examination is permanently negative within 40 weeks of their stay in the CSSR.     

Epidemiology of Necator americanus hookworm infections in Xiulongkan Village, Hainan Province, China: high prevalence and intensity among middle-aged and elderly residents

Hookworm is highly endemic to Hainan Province, an island located in the South China Sea. To investigate the prevalence and intensity of infection in the area, the village of Xiulongkan was surveyed between April and July 1998. A cross-sectional study was conducted in which fecal samples of 80% of the village residents (631 individuals) were tested for the presence of helminth eggs. Hookworm was the predominant intestinal helminth in Xiulongkan, where it was determined that 60% of those tested were infected. Necator americanus was the predominant species of hookworm in this population. The prevalence of hookworm increased with age, and then leveled to a plateau for ages 41 yr and up. This observation was in contrast to infections with Ascaris lumbricoides, where the highest prevalences occurred among school-aged children. Women had a significantly higher prevalence of hookworm than men and this difference emerged in early adulthood. The intensity of hookworm infection also significantly increased with age, with the highest intensity infections occurring among middle-aged and elderly residents. Females were more likely to have moderate or heavy infections, whereas males were more likely to have light infections. The rates of hookworm transmission are particularly high among the middle-aged and elderly residents of Xiulongkan.     

Risk Profiling of Hookworm Infection and Intensity in Southern Lao People’s Democratic Republic Using Bayesian Models

BackgroundAmong the common soil-transmitted helminth infections, hookworm causes the highest burden. Previous research in the southern part of Lao People’s Democratic Republic (Lao PDR) revealed high prevalence rates of hookworm infection. The purpose of this study was to predict the spatial distribution of hookworm infection and intensity, and to investigate risk factors in the Champasack province, southern Lao PDR.MethodologyA cross-sectional parasitological and questionnaire survey was conducted in 51 villages. Data on demography, socioeconomic status, water, sanitation, and behavior were combined with remotely sensed environmental data. Bayesian mixed effects logistic and negative binomial models were utilized to investigate risk factors and spatial distribution of hookworm infection and intensity, and to make predictions for non-surveyed locations.Conclusions/SignificanceHookworm transmission seems to occur within, rather than between villages in Champasack province. We present spatial risk maps of hookworm infection and intensity, which suggest that control efforts should be intensified in the Champasack province, particularly in mountainous areas.     

Ancylostoma ceylanicum infections in humans in Vietnam

Ancylostoma ceylanicum is recognized as the only zoonotic hookworm species that is able to mature into adult stage in the human intestine. While human infections caused by this hookworm species have been reported from neighboring countries and this hookworm is prevalent in dogs in Vietnam, human infection has never been reported in Vietnam. The present study, therefore, aimed to identify human infections with A. ceylanicum in Vietnam. A total of 526 fecal samples from the residents in Long An Province were collected and the presence of hookworm eggs was detected by the Kato-Katz method. The results indicated that the overall prevalence of human hookworm infection was 85/526 (16.2%). After filter paper culture, 3rd stage larvae were successfully obtained from 48 egg-positive samples. The larvae were identified for their species using semi-nested PCR-RLFP on the cox1 gene. As a result, two hookworm species were confirmed; single species infections with Necator americanus or A. ceylanicum, and mixed infections with both species were found in 47.9%, 31.3%, and 20.8% of the samples, respectively.