Why Are We Still a Worm World in the 2020s? An Overview of Risk Factors and Endemicity for Soil-Transmitted Helminthiasis.

PURPOSE: Soil-transmitted helminthiasis (STH) is one of the most common chronic infections in developing countries associated with poor socioeconomic and sanitary conditions. The main objective of this overview was to evaluate the influence of environmental factors, risk factors related to the host, and control strategies on the prevalence of STH in different regions of the world. METHODS: LILACS, PubMed, Web of Knowledge, Embase, the Cochrane Library, and Clinical Trials (gray literature) databases were used to obtain the systematic reviews published until December 2020. The methodological quality of systematic reviews was assessed using the standard criteria recommended by AMSTAR. RESULTS: The initial results of the bibliographic search identified 1448 articles, of which 66 studies were read in full and 16 met the inclusion criteria. All the reviews included in this overview associated variations in the global prevalence of STH with at least one of the factors related to the environment, host, and/or control strategies. Climate, temperature, soil moisture, precipitation, mass drug administration, lack of access to water, sanitation and hygiene (WASH), and non-use of footwear were considered the main factors associated with the prevalence of STH. Socioeconomic factors, low educational level, and wearing shoes were universal factors related to prevalence, regardless of the location studied. CONCLUSION: The combination of environmental factors, with factors associated with hosts that predispose infection and reinfection of helminths, as well as the adoption of control strategies based on the treatment of target populations instead of the entire population, influenced the prevalence of STH in all the continents evaluated.

Accuracy Study of Kato-Katz and Helmintex Methods for Diagnosis of Schistosomiasis Mansoni in a Moderate Endemicity Area in Sergipe, Northeastern Brazil.

Schistosomiasis is a neglected tropical disease (NTD) caused by blood flukes from the genus Schistosoma. Brazil hosts the main endemic area in the Americas, where Schistosoma mansoni is the only species causing the disease. Kato-Katz (KK) thick smear is the WHO recommended screening test for populational studies, but there is growing evidence for the sensitivity limitations associated with KK, especially in areas with low parasite loads. Helmintex (HTX) is another highly sensitive egg-detection method, based on the magnetic properties of S. mansoni eggs and their isolation in a magnetic field. The objective of this study is to evaluate both KK and HTX in a moderate endemic locality, Areia Branca, located in the municipality of Pacatuba, in the state of Sergipe in northeastern Brazil. From 234 individual fecal samples, two KK thick smears were prepared and evaluated for each sample. Similarly, 30 g of each fecal sample was processed by HTX protocol. Eggs were detected in 80 (34.18%) residents. Twenty-three (9.83%) samples were positive for eggs (only by KK), and 77 (32.91%) samples showed positive for eggs (only by HTX). Sensitivity, specificity, and accuracy estimates gave values of 28.75%, 100% and 75.64%, respectively, for KK, and 96.25%, 100% and 98.72% respectively, for HTX. The positive predictive value was 100% for both methods, while the negative predictive value was 72.99% for KK and 98.09% for HTX. Overall, HTX presented a superior performance compared to the one sample, two slides KK examination. The study confirms the role of HTX as a reference method for the definition of true-positive samples in comparative accuracy studies and its potential role in the late stages when the certification of schistosomiasis transmission interruption is required. Diagnostic tests are important tools for the elimination of this NTD, besides the effective implementation of safe water, basic sanitation, snail control, and the treatment of infected populations.

Neuroendocrine effects of a single bout of functional and core stabilization training in women with chronic nonspecific low back pain: A crossover study.

Exercise-induced hypoalgesia (EIH) is characterized as the pain reduction after an exercise session and it seems to be related to the release of plasma ß-endorphin. In this sense, the core stabilization training (CT) has been suggested for patients with chronic nonspecific low back pain (CNSLBP), but it is unclear whether it induces EIH. Patients with CNSLBP have neuromotor dysfunctions that can affect the performance of functional tasks, thus, performing functional training (FT) could improve motor control and promote EIH, since functional training uses multi-joint exercises that aim to improve the functionality of actions performed in daily life. EIH is usually assessed using quantitative sensory tests (QST) such as conditioned pain modulation, pressure pain threshold, and temporal summation. Thus, the sum of parameters from quantitative sensory tests and plasma ß-endorphin would make it possible to understand what the neuroendocrine effects of FT and CT session are. Our study compared the acute effect of CT and FT on the EIH and plasma ß-endorphin release, and correlated plasma ß-endorphin with quantitative sensory testing in patients with CNSLBP. Eighteen women performed two training sessions (CT and FT) with an interval of 48 h between sessions. EIH was assessed by QST and plasma ß-endorphin levels. Results showed that only FT significantly increased plasma ß-endorphin (FT p < 0.01; CT p = 0.45), which correlated with pain pressure threshold (PPT) and conditioned pain modulation (CPM). However, QST values were not different in women with CNSLBP after CT or FT protocols. Plasma ß-endorphin correlated with PPT and CPM, however, the same did not occur with a temporal summation.

Genetic Background Affects the Mucosal Secretory IgA Levels, Parasite Burden, Lung Inflammation, and Mouse Susceptibility to Ascaris suum Infection.

Ascariasis is a neglected tropical disease that is widespread in the world and has important socioeconomic impacts. The presence of various stages of worm development in the pulmonary and intestinal mucosae induces a humoral and cellular immune response. However, although there is much evidence of the protective role of mucosal immunity against various pathogens, including helminths, there is still a gap in the knowledge about the immune response and the mechanisms of action that are involved in protection against diseases, especially in the initial phase of ascariasis. Thus, the aim of this study was to evaluate the kinetic aspects of the immune parasitological parameters in intestinal and pulmonary mucosae in male mice with early ascariasis. Therefore, two mouse strains that showed different susceptibilities to ascariasis (BALB/c and C57BL/6J) when experimentally infected with 2,500 infective eggs of Ascaris suum from time point 0 were examined: the immune parasitological parameters were evaluated each 2 days after infection over a period of 12 days. The results were suggestive of a synergetic action of intestinal and pulmonary secretory IgA (S-IgA) contributing to protection against early ascariasis by reducing the amount of migrating larvae as well as the influx of leukocytes in the lung and the consequent impairment of pulmonary capacity.

Eosinophils mediate SIgA production triggered by TLR2 and TLR4 to control Ascaris suum infection in mice.

Human ascariasis is the most prevalent but neglected tropical disease in the world, affecting approximately 450 million people. The initial phase of Ascaris infection is marked by larval migration from the host's organs, causing mechanical injuries followed by an intense local inflammatory response, which is characterized mainly by neutrophil and eosinophil infiltration, especially in the lungs. During the pulmonary phase, the lesions induced by larval migration and excessive immune responses contribute to tissue remodeling marked by fibrosis and lung dysfunction. In this study, we investigated the relationship between SIgA levels and eosinophils. We found that TLR2 and TLR4 signaling induces eosinophils and promotes SIgA production during Ascaris suum infection. Therefore, control of parasite burden during the pulmonary phase of ascariasis involves eosinophil influx and subsequent promotion of SIgA levels. In addition, we also demonstrate that eosinophils also participate in the process of tissue remodeling after lung injury caused by larval migration, contributing to pulmonary fibrosis and dysfunction in re-infected mice. In conclusion, we postulate that eosinophils play a central role in mediating host innate and humoral immune responses by controlling parasite burden, tissue inflammation, and remodeling during Ascaris suum infection. Furthermore, we suggest that the use of probiotics can induce eosinophilia and SIgA production and contribute to controlling parasite burden and morbidity of helminthic diseases with pulmonary cycles.

T follicular helper cells: Their development and importance in the context of helminthiasis.

The development of T follicular helper cells (Tfh) is a multifactorial process that occurs in multiple stages. After their activation the Tfh cells interact with the B cells to complete their differentiation. During this process, the Tfh cells begin to express canonical molecules such as the transcription factor B-cell lymphoma 6 protein, the CXC chemokine receptors type 5, and the inducible T-cell costimulator, as well as secreting other molecules such as IL-21. This whole process is regulated positively and negatively by several factors so that the best response is offered in the face of diseases of various origins, among them helminthiasis. In this context, the role of circulating Tfh, IL-4 and IgG subtypes is essential for an effective response against these pathogens. In this review, the migration process and the differentiation of Tfh, the regulation, their cell subtypes and the role of Tfh in the context of helminth infections will be addressed.

Time-course of changes in performance, biomechanical, physiological and perceptual responses following resistance training sessions.

This study determined the time-course of recovery after resistance training (RT) sessions and the association between changes in performance with changes in biomechanical, physiological and perceptual parameters. After a 4-week familiarization period, 14 resistance-trained males performed 3 experimental conditions, each one including 2 sessions with a recovery interval of 24, 48 h or 72 h, in a randomized order. RT sessions consisted of 5 sets of 8-10RM on squat and leg press exercises. The resistance was equal for the 2 sessions of each condition and repetitions were performed until concentric failure. Volume load (VL) and first set volume load (FSVL) were compared between sessions. Tests before each session included countermovement jump (CMJ), maximal voluntary isometric contraction (MVIC), creatine kinase (CK) and delayed onset muscle soreness (DOMS). (2 × 3) ANOVA with effect sizes (ES) assessed the time-course of recovery and Kendall test the correlation between variables (α = 0.05). Significant interaction was observed for all variables, except for CK, where a condition main effect occurred. Comparisons between post and pre-intervals showed VL (p = 0.011;ES = -0.90) decreased for 24 h condition, while FSVL remained decreased for 48 h (p = 0.031;ES = -0.63) and DOMS increased (p = 0.001;ES = 3.52). CMJ (p = 0.025;ES = 0.25) and MVIC (p = 0.031;ES = 0.14) performance increased at 72 h. FSVL (r = 0.424), CMJ (r = 0.439), MVIC (r = 0.389) and DOMS (r = -0.327) were significantly correlated with VL (p < 0.05). Time-course of VL showed the necessity of at least 48 h for the reestablishment of performance, though better perceptual responses were evident at 72h. Thus, both recovery intervals may be beneficial after lower-limbs RT until concentric failure, though chronic effects still need to be investigated.

Interleukin-10 promoter gene polymorphisms are associated with the first major depressive episode in chronic hepatitis C patients.

AIMS: To investigate the association of IL10 SNPs in chronic hepatitis C (CHC) patients with and without the first major depressive episode (MDE), as well as their association with plasma levels of target cytokines. METHODS: A hundred and thirty two CHC patients (32 with and 100 without first MDE) and 98 controls were prospectively enrolled in this cross-sectional study. MDE was diagnosed by a psychiatrist, using the Mini International Neuropsychiatric Interview Plus 5.0. IL10 polymorphisms (-1082 G/A, -819C/T and -592C/A IL10 SNPs) were evaluated by Taqman SNP genotyping assay. Plasma concentrations of IL-2, IL-6, IL-10, IFN-γ and TNF-α were determined using the Human Th1/Th2 Cytometric Bead Array kit. The associations were investigated by logistic models. RESULTS: The frequencies of the studied IL10 SNPs did not differ between the CHC patients and controls. The first MDE was positive and independently associated with the IL10-1082*A, IL10-819*T and IL10-592*A (ATA) low producer haplotype (OR = 1.50; 95% CI = 1.11-2.04; P = 0.009) and current alcohol misuse (OR = 4.29; 95% CI = 1.22-15.05; P = 0.02), and inversely associated with increasing age (OR = 0.94; 95% CI = 0.91-0.98; P = 0.006). In addition, plasma level of TNF-α was significantly higher in the carriers than in the non-carriers of the IL10 ATA haplotype in patients with the first MDE. The IL-10 and IL-2 plasma levels were significantly higher in the carriers than in non-carriers of the IL10 GCC high producer haplotype, demonstrating the functionality of the studied IL10 polymorphisms. CONCLUSIONS: This is the first study to demonstrate that the IL10 low producer ATA haplotype is associated with the first MDE in patients with CHC.

Concomitant helminth infection downmodulates the Vaccinia virus-specific immune response and potentiates virus-associated pathology.

The aim of this work was to elucidate the immunopathological mechanisms of how helminths may influence the course of a viral infection, using a murine model. Severe virulence, a relevant increase in the virus titres in the lung and a higher mortality rate were observed in Ascaris and Vaccinia virus (VACV) co-infected mice, compared with VACV mono-infected mice. Immunopathological analysis suggested that the ablation of CD8+ T cells, the marked reduction of circulating CD4+ T cells producing IFN-γ, and the robust pulmonary inflammation were associated with the increase of morbidity/mortality in co-infection and subsequently with the negative impact of concomitant pulmonary ascariasis and respiratory VACV infection for the host. On the other hand, when evaluating the impact of the co-infection on the parasitic burden, co-infected mice presented a marked decrease in the total number of migrating Ascaris lung-stage larvae in comparison with Ascaris mono-infection. Taken together, our major findings suggest that Ascaris and VACV co-infection may potentiate the virus-associated pathology by the downmodulation of the VACV-specific immune response. Moreover, this study provides new evidence of how helminth parasites may influence the course of a coincident viral infection.

Multiple Exposures to Ascaris suum Induce Tissue Injury and Mixed Th2/Th17 Immune Response in Mice.

Ascaris spp. infection affects 800 million people worldwide, and half of the world population is currently at risk of infection. Recurrent reinfection in humans is mostly due to the simplicity of the parasite life cycle, but the impact of multiple exposures to the biology of the infection and the consequences to the host's homeostasis are poorly understood. In this context, single and multiple exposures in mice were performed in order to characterize the parasitological, histopathological, tissue functional and immunological aspects of experimental larval ascariasis. The most important findings revealed that reinfected mice presented a significant reduction of parasite burden in the lung and an increase in the cellularity in the bronchoalveolar lavage (BAL) associated with a robust granulocytic pulmonary inflammation, leading to a severe impairment of respiratory function. Moreover, the multiple exposures to Ascaris elicited an increased number of circulating inflammatory cells as well as production of higher levels of systemic cytokines, mainly IL-4, IL-5, IL-6, IL-10, IL-17A and TNF-α when compared to single-infected animals. Taken together, our results suggest the intense pulmonary inflammation associated with a polarized systemic Th2/Th17 immune response are crucial to control larval migration after multiple exposures to Ascaris.

Acral microcystic lymphangioma: differential diagnosis in verrucous lesions of the extremities.

Lymphangiomas are a malformation caused by the abnormal migration of lymphatic tissue, leading to failures in the communication and drainage of the lymphatic system. They usually present as groups of translucent papules and vesicles in the skin or mucous membranes. Presentation as a verrucous plaque limited to a single toe is unusual and emphasizes the relevance of this case report. Although considered a benign lesion, depending on the site affected by the lymphangioma and its size, it may lead to localized pain or recurrent infections, substantially affecting the patient's quality of life. The present case report describes a patient with lymphangioma of late onset developing in adulthood in the form of a verrucous plaque confined to a single toe. Diagnosis of this unusual presentation could only be confirmed following histopathology. Surgical excision resulted in a satisfactory functional and cosmetic outcome.

Linfangioma microcístico acral: diagnóstico diferencial em lesões verrucosas de extremidades / Acral microcystic lymphangioma: differential diagnosis in verrucous lesions of the extremities

Linfangioma é uma má-formação originária da migração anormal de tecido linfático, levando a falhas na comunicação e na drenagem da linfa. Apresenta-se mais comumente como vésico-pápulas agrupadas de conteúdo translúcido na pele ou mucosas. A apresentação inicial na forma de placa verrucosa limitada a um único pododáctilo é atípica e reforça a relevância deste relato. Ainda que considerado lesão benigna, o linfangioma, a depender de sua localização e dimensão, pode apresentar dor local ou infecções recorrentes, com interferência substancial na qualidade de vida. Relatamos caso de linfangioma circunscrito a pododáctilo de surgimento tardio na idade adulta, na forma de placa verrucosa - apresentação atípica confirmada apenas após histopatológico. A excisão cirúrgica garantiu resposta estética e funcional satisfatória.

Lymphangiomas are a malformation caused by the abnormal migration of lymphatic tissue, leading to failures in the communication and drainage of the lymphatic system. They usually present as groups of translucent papules and vesicles in the skin or mucous membranes. Presentation as a verrucous plaque limited to a single toe is unusual and emphasizes the relevance of this case report. Although considered a benign lesion, depending on the site affected by the lymphangioma and its size, it may lead to localized pain or recurrent infections, substantially affecting the patient's quality of life. The present case report describes a patient with lymphangioma of late onset developing in adulthood in the form of a verrucous plaque confined to a single toe. Diagnosis of this unusual presentation could only be confirmed following histopathology. Surgical excision resulted in a satisfactory functional and cosmetic outcome.

Angiossarcoma primário em couro cabeludo e hanseníase virchowiana: associação incomum em paciente idosa / Primary angiosarcoma of the scalp and lepromatous leprosy: an uncommon combination in an elderly patient

Introdução: Os sarcomas cutâneos primários são neoplasias mesenquimais raras e de grande heterogeneidade histopatológica. O angiossarcoma é um subtipo de sarcoma cutâneo maligno pouco comum, que atinge preferencialmente homens idosos. De localização típicamente cefálica, apresenta-se como lesões multifocais que levam a edema, sangramento e ulceração locais. São agressivos, de crescimento rápido e difícil delimitação de margens cirúrgicas, o que explica altas taxas de recorrência. Descreve-se caso de angiossarcoma primário em couro cabeludo de paciente idosa em uso de poliquimioterapia para hanseníase virchowiana. Associação de angiossarcoma e hanseníase é incomum. A ausência de relatos semelhantes na literatura motivou a descrição do caso.

Aspectos funcionais e fenotípicos de Linfócitos T CD4+ de pacientes portadores da forma crônica intestinal da esquistossomose mansoni na ausência ou presença de co-infecções por geo-helmintos

Infecções helmínticas representam uma das mais prevalentes doenças parasitáriasdo mundo, sendo as co-infecções freqüentemente observadas em áreas endêmicas.Têm-se postulado que as infecções helmínticas podem aumentar a susceptibilidadea outras infecções ou agir de maneira sinérgica na ativação dos mecanismos imunesprotetores. Neste contexto, a resposta imune celular específica e o perfil deexpressão de citocinas, fatores importantes na ativação de mecanismos protetores jáforam avaliados. Entretanto, pouco se sabe sobre os fatores e mecanismos quelevam à imunidade protetora ou que contribuem para a persistência dos parasitosem humanos co-infectados por Schistosoma mansoni e geo-helmintos. Neste estudonós avaliamos a resposta imune celular de linfócitos T (LT) CD4+ de pacientes comesquistossomose intestinal na ausência (XTO) ou presença (CO) de co-infecçõespor geo-helmintos. Células mononucleadas do sangue periférico (PBMC) foramestimuladas por antígenos brutos de ovos (SEA) ou de vermes adultos (SWAP) deS. mansoni. Análises da incorporação de BrdU (fase S do ciclo celular) e do fenótipocelular (tais como CD4 e marcadores de ativação) foram realizadas por citometria defluxo. Nossos resultados demonstram maior envolvimento de LT CD3+ comparadosaos linfócitos B (LB) CD19+. Após estimulação in vitro com SWAP, o percentualmédio de LB CD19+ dos pacientes do grupo XTO foi maior comparado com aqueleobservado em indivíduos não infectados. Entretanto, nenhuma diferença significativana freqüência e reatividade das subpopulações de LT CD3+ foi observada entre osgrupos. Contudo, observamos uma subpopulação de LT expressando altos níveis damolécula CD4 (CD4HIGH) que apresentou diferentes perfis de reatividade apósestimulação in vitro. Nas culturas estimuladas com SWAP foi observada uma maiorfreqüência de LT CD4HIGH reativos em pacientes do grupo XTO comparada àquelaobservada no grupo CO, mas semelhante ao grupo NI. Análises de marcadores deativação/memória demonstraram maio...

Aspectos funcionais e fenotípicos de Linfócitos T CD4+ de pacientes portadores da forma crônica intestinal da esquistossomose mansoni na ausência ou presença de co-infecções por geo-helmintos / Functional and phenotipic aspects of CD4+ T lymphocytes from patients with cronic intestinal clinical form of schistosomiasis in the absence or presence of geohelminthes coinfections

Infecções helmínticas representam uma das mais prevalentes doenças parasitáriasdo mundo, sendo as co-infecções freqüentemente observadas em áreas endêmicas.Têm-se postulado que as infecções helmínticas podem aumentar a susceptibilidadea outras infecções ou agir de maneira sinérgica na ativação dos mecanismos imunesprotetores. Neste contexto, a resposta imune celular específica e o perfil deexpressão de citocinas, fatores importantes na ativação de mecanismos protetores jáforam avaliados. Entretanto, pouco se sabe sobre os fatores e mecanismos quelevam à imunidade protetora ou que contribuem para a persistência dos parasitosem humanos co-infectados por Schistosoma mansoni e geo-helmintos. Neste estudonós avaliamos a resposta imune celular de linfócitos T (LT) CD4+ de pacientes comesquistossomose intestinal na ausência (XTO) ou presença (CO) de co-infecçõespor geo-helmintos. Células mononucleadas do sangue periférico (PBMC) foramestimuladas por antígenos brutos de ovos (SEA) ou de vermes adultos (SWAP) deS. mansoni. Análises da incorporação de BrdU (fase S do ciclo celular) e do fenótipocelular (tais como CD4 e marcadores de ativação) foram realizadas por citometria defluxo. Nossos resultados demonstram maior envolvimento de LT CD3+ comparadosaos linfócitos B (LB) CD19+. Após estimulação in vitro com SWAP, o percentualmédio de LB CD19+ dos pacientes do grupo XTO foi maior comparado com aqueleobservado em indivíduos não infectados. Entretanto, nenhuma diferença significativana freqüência e reatividade das subpopulações de LT CD3+ foi observada entre osgrupos. Contudo, observamos uma subpopulação de LT expressando altos níveis damolécula CD4 (CD4HIGH) que apresentou diferentes perfis de reatividade apósestimulação in vitro. Nas culturas estimuladas com SWAP foi observada uma maiorfreqüência de LT CD4HIGH reativos em pacientes do grupo XTO comparada àquelaobservada no grupo CO, mas semelhante ao grupo NI. Análises de marcadores deativação/memória demonstraram maio...