The Effect of Deworming on Tests of Tuberculosis Infection in Children With Recent Tuberculosis Exposure: A Randomized Controlled Trial. Issue 6 (June 2016)

• Record Type: Journal Article
• Authors: Van der Zalm, Marieke M.; van Soelen, Nelda; Mandalakas, Anna M.; Jacobsen, Marc; Detjen, Anne K.; Marx, Florian M.; Grewal, Harleen M. S.; Cotton, Mark F.; Walzl, Gerhard; Hesseling, Anneke C.
• Is Part Of: Pediatric infectious disease journal. Volume 35:Issue 6(2016)
• Publication Date: 2016-06
• Subjects: helminths -- Ascaris -- children -- TB infection -- TST -- QTF -- deworming; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000001115
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: Helminth infestations are associated with T-helper cell type 2 (Th2) immune responses, leading to suppression of Th1 responses required to control Mycobacterium tuberculosis infection. We hypothesized that deworming after documented M. tuberculosis exposure might improve Th1 immune responses. Methods: This was a randomized controlled trial comparing the effect of early versus delayed (after 3 months) deworming on tuberculin skin testing (TST) and Quantiferon-Gold-in-tube responses among children from a setting with a known high burden of M. tuberculosis and helminth co-infection in Cape Town, South Africa. Children aged 6 to 15 years with documented M. tuberculosis exposure were enrolled. Ascaris lumbricoides status was measured by Ascaris -specific IgE and stool microscopy. Results: A total of 250 children (mean age, 9.6 years) were enrolled; 11.9% (27/227) were Ascaris stool microscopy positive and 54.2% (135/249) were Ascaris stool and/or IgE positive ( Ascaris status). In univariable analysis, deworming at enrollment was not associated with a negative TST at 3 months (odds ratio, 0.61; 95% confidence interval, 0.35–1.07; P = 0.08). In stratified analysis, children with a positive Ascaris status were more likely to be TST negative at 3 months if dewormed early (odds ratio, 0.49; 95% confidence interval, 0.23–1.04; P = 0.06). In multivariable analysis, deworming was not associated with TST status (adjusted odds ratios, 0.62; 95% confidence interval, 0.34–1.10; P = 0.10). There was no association between deworming and Quantiferon-Gold-in-tube status. Conclusions: Deworming in children with recent M. tuberculosis exposure is associated with a trend toward a negative TST result. Timing of deworming might influence interpretation of TST in settings with high burdens of tuberculosis and helminths. Abstract : Supplemental Digital Content is available in the text.