02134nas a2200229   4500000000100000008004100001100001200042700001500054700001400069700001100083700001200094700001500106700001600121700001300137700001200150700001100162700001200173245008800185856006600273520155100339022001401890       2017                            d1 aHagge D1 aParajuli P1 aKunwar CB1 aRana D1 aThapa R1 aNeupane KD1 aNicholls PG1 aAdams LW1 aGeluk A1 aShah M1 aNapit I00aOpening a can of worms: leprosy reactions and complicit soil-transmitted helminths.  uhttp://www.ebiomedicine.com/article/S2352-3964(17)30343-2/pdf3 a<p><strong>BACKGROUND: </strong>&gt;94% of new annual leprosy cases are diagnosed in populations co-endemic for soil-transmitted helminths (STH). STH can profoundly dysregulate host immune responses towards Th2 bias, which can be restored over time after deworming. We hypothesize that STH co-infection is associated with leprosy reaction (denoted as simply "reaction" herein) occurrence within a co-endemic population.</p>

<p><strong>METHODS: </strong>A cohort study was performed on Nepalese leprosy patients across treatment and diagnostic classifications were screened by routine fecal smear microscopy and multiplex quantitative PCR (qPCR) for Ascaris lumbricoides (Al), Strongyloides stercoralis (Ss), Ancyclostoma duodenale (Ad) and Necator americanus (Na).</p>

<p><strong>RESULTS: </strong>Among 145 patients, 55% were positive for ≥1 STH (STH+): 34% Al+, 18% Ss+, 17% Ad+and 5% Na+. Significant inverse STH and reaction relationships were evidenced by the bulk of cases: 63% reaction-negative were STH+ of total cases (p=0.030) while 65% reaction-positive were STH- in new cases (96; p=0.023). Strikingly, the majority of STH+ were reaction-negative, even when considering each species: 59% Al+, 60% Ss+, 62% Ad+and 67% Na+of new leprosy cases.</p>

<p><strong>CONCLUSIONS: </strong>Absence of STH co-infection is associated with leprosy reaction at diagnosis within a co-endemic population. This is likely due to immune reconstitution effects after deworming or interruption of chronic STH-mediated immune dysregulation.</p>
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