Soil-Transmitted Helminths and Anaemia: A Neglected Association Outside the Tropics
Abstract
:1. Introduction
2. Methods
3. Global Burden
4. Biological Features and Lifecycle
5. Pathophysiology and Clinical Spectrum
6. Association with Anaemia
Hookworms | Whipworm | Roundworm | Threadworm | ||
---|---|---|---|---|---|
Ancylostoma duodenale | Necator americanus | Trichiuris trichiura | Ascaris lumbricoides | Strongyloides stercoralis | |
Direct association with anemia | Indirect association with anemia | ||||
| | | | ||
Mechanism/s | Attachment to the gut mucosa and submucosa through their teeth | Attachment to the gut mucosa and submucosa through their cutting plates | Gut epithelial and endothelial barrier disruption in the entry site | Gut epithelial and endothelial barrier disruption in the entry site | Gut epithelial and endothelial barrier disruption in the entry site |
Secretion of anticoagulants to prevent blood clotting. Downregulation of the host inflammatory response | Secretion of anticoagulants to prevent blood clotting and downregulate the host inflammatory response | Rupture of capillaries and arterioles within the intestinal tissue, leading to blood loss | Rupture of capillaries and arterioles within the intestinal tissue, leading to blood loss | Probably poor nutrient absorption and disruption of intestinal flora | |
Severity | 0.2 mL/day/worm (standard deviation of ±0.045 mL) [25]. Blood loss 10-fold higher than N.americanus | 0.05–0.15 mL/day/worm -heavy infections can produce losses of >1 mL daily [18] | 0.005 mL/day/worm [29] | Not determinable | Not determinable |
Host’s erythrocytes are digested in the gastrointestinal tract of the hookworm; depletion of iron reserves, hyproteinaemia | Host’s erythrocytes are partially digested by the gastrointestinal tract of the hookworm; depletion of iron reserves, hyproteinaemia | Chronic blood oozing in the caecum and colon through the mucosal entry sites; depletion of iron reserves | Intestinal obstruction and perforation; malnutrition | Not determinable | |
In heavy-intensity infections, blood loss can result in severe anaemia | The severity of blood loss positively correlates with parasite burden | Severe anemia in vulnerable groups (e.g., pregnant women and children) | Severe anemia in vulnerable groups (e.g., pregnant women and children) | Not determinable | |
Accompanying clinical elements | In moderate/heavy infections, IDA, hypoalbuminaemia and hypoproteinaemia can occur; hypoproteinaemia can cause peripheral oedema, ascites, and, in severe cases, a clinical picture that resembles kwashiorkor | In moderate/heavy infections, IDA, hypoalbuminaemia and hypoproteinaemia can occur; hypoproteinaemia can cause peripheral oedema, ascites, and, in severe cases, a clinical picture that resembles kwashiorkor. In heavy infections, anemia ensues even when adequate dietary intake is maintained | IDA and poor nutrient adsorbition. Impaired nutrient absorption and disruption of intestinal flora can contribute to growth retardation and anemia in children. Massive infantile trichiuriasis is a severe illness including IDA, chronic mucoid diarrhoea, rectal bleeding, rectal prolapse | Gastrointestinal bleeding, small bowel obstruction, volvulus, intussusception, peritonitis, intestinal ischemia, and perforation. Chronic ascariasis may be associated with malnutrition, which is caused by malabsorption of dietary protein, fat, vitamins. | In the chronic phase, strongyloidiasis may cause intermittent symptoms that mostly affect the intestine (abdominal pain and intermittent or persistent diarrhoea) |
7. Diagnostic Approach
8. Treatment
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Caldrer, S.; Ursini, T.; Santucci, B.; Motta, L.; Angheben, A. Soil-Transmitted Helminths and Anaemia: A Neglected Association Outside the Tropics. Microorganisms 2022, 10, 1027. https://doi.org/10.3390/microorganisms10051027
Caldrer S, Ursini T, Santucci B, Motta L, Angheben A. Soil-Transmitted Helminths and Anaemia: A Neglected Association Outside the Tropics. Microorganisms. 2022; 10(5):1027. https://doi.org/10.3390/microorganisms10051027
Chicago/Turabian StyleCaldrer, Sara, Tamara Ursini, Beatrice Santucci, Leonardo Motta, and Andrea Angheben. 2022. "Soil-Transmitted Helminths and Anaemia: A Neglected Association Outside the Tropics" Microorganisms 10, no. 5: 1027. https://doi.org/10.3390/microorganisms10051027