An Exploratory Analysis of Associations between Hansen’s Disease, Schistosomiasis and Strongyloidiasis in Minas Gerais, Brazil Open Access

Abstract

An Exploratory Analysis of Associations between Hansen’s Disease, Schistosomiasis and Strongyloidiasis in Minas Gerais, Brazil

By Esther Amoakohene

Background: Hansen’s disease (Leprosy), schistosomiasis (Bilharzia) and strongyloidiasis are Neglected Tropical Diseases (NTDs) that are of significant public health concern in Brazil due to high endemicity, crippling effects and difficulty in early detection. The overall goals of this study were to explore the relationship between Hansen’s disease (HD) and these helminths, to describe seroprevalence of these NTDs by analyzing data gathered utilizing a new testing method (Multiplex Bead Assay) and to garner information that might aid in the development of new strategies for NTD control.

Methods: Data from a case-control study conducted in Minas Gervais, Brazil was used for this analysis. Patients 3 years old and above were recruited and classified into HD positive, HD negative with no contact and HD with contact. Demographic data was collected via questionnaire, active HD cases were determined via slit skin smear tests and NTD antigens were detected via the multiplex serological testing. Chi square and regression analyses were conducted using SAS 9.4.

Results: Of the 221 participants involved in the analysis 78 were positive for HD, 87 participants were in control 1 and 67 were in control 2. Among the HD positive cases, 22 were classified as PB and 56 where MB. 34 participants tested positive for LID-1. Results from the analyses indicated that there was no statistically significant association between current HD status and helminth infection (schistosomiasis: control 1, cOR=1.02, 95%CI=0.55-1.87; control 2, cOR=0.76, 95%CI=0.39-1.47. strongyloidiasis. MBA results, utilizing NTD antigens, showed a negative association between HD antibodies (anti-LID-1) and schistosomiasis (cOR= 0.36, 95%CI=0.13-0.96) and a positive association between strongyloidiasis (cOR= 2.64, 95%CI=1.19-5.88). We also detected a higher number of schistosomiasis exposed individuals (n=66) compared to stool testing (n=12). Additionally, HD antibodies (LID-1) were detected in persons that did not have active HD.

Discussion: Results of this study encourage further exploration on the relationship between HD and schistosomiasis, the use of MBA on multiple helminth or early helminth infection detection, as well as follow up research on the risks of developing active HD after testing positive for LID-1 and other helminth antigens.

Table of Contents

Introduction. 1

Hansen’s Disease. 1

Schistosomiasis and strongyloidiasis. 2

Literature review. 6

Hansen’s disease and helminth related immune response. 6

Hansen’s disease and helminth relationship. 7

 Hansen’s Disease, schistosomiasis and strongyloidiasis in brazil. 11

Methods. 14

Results. 19

Discussion. 26

Bibliography. 30

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Neglected Tropical Disease Infectious disease
Committee Chair / Thesis Advisor	Fairley, Jessica, Emory University

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