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COINCIDENT FILARIAL, INTESTINAL HELMINTH, AND MYCOBACTERIAL INFECTION: HELMINTHS FAIL TO INFLUENCE TUBERCULIN REACTIVITY, BUT BCG INFLUENCES HOOKWORM PREVALENCE

The prevalence of helminth and tuberculosis infections is high in South India, whereas Bacille-Calmette-Guerin (BCG) vaccine efficacy is low. Our aim was to determine whether concurrent helminth infection alters the ability to mount a delayed-type hypersensitivity response to tuberculin. In a cross-sectional study in southern India, individuals 6–65 years of age were screened for intestinal helminths, circulating filarial antigenemia, tuberculin reactivity, active tuberculosis, and history of BCG vaccination; 54% were purified protein derivative (PPD) positive, 32% had intestinal helminth infection, 9% were circulating filarial antigen positive, and 0.5% had culture-confirmed active tuberculosis. Only age and BCG vaccination were significantly associated with PPD reactivity; however, BCG vaccination was associated with a lower prevalence of hookworm infection relative to those without prior BCG vaccination. Neither intestinal helminth infection nor filarial infection was associated with diminished frequencies of PPD positivity. Our findings suggest that preceding helminth infection does not influence significantly the delayed-type hypersensitivity response to tuberculin.

Received August 30, 2005. Accepted for publication December 16, 2005.

Acknowledgments: We thank Brenda Rae Marshall for editorial assistance

Financial support: This work was supported in part by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health.

Informed consent was obtained from all study subjects before enrollment; for those under the age of 18, parental consent and assent from minors was obtained.

The study protocol was reviewed and approved by the Institutional Review Boards of the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, and by the Tuberculosis Research Centre Chennai India; the protocol was also approved by the Health Ministry Screening Committee, New Delhi, India.

^* Address correspondence to Thomas B. Nutman, LPD, NIAID, 4 Center Drive, Room 4/126, NIH, Bethesda, MD 20892. E-mail: tnutman{at}niaid.nih.gov

Authors’ addresses: Ettie M. Lipner, Office of Global Research, National Institute of Allergy and Infectious Diseases, 6610 Rockledge, Room 2037, National Institutes of Health, Bethesda, MD 20892, E-mail: elipner{at}niaid.nih.gov. P. G. Gopi, Tuberculosis Research Centre, Mayor V. R. Ramanathan Road (Spur Tank Road), Chetpet, Chennai 600 031, India, E-mail: pg-gopi{at}rediffmail.com. R. Subramani, Tuberculosis Research Centre, Mayor V. R. Ramanathan Road (Spur Tank Road), Chetpet, Chennai 600 031, India. C. Kolappan, Tuberculosis Research Centre, Mayor V. R. Ramanathan Road (Spur Tank Road), Chetpet, Chennai 600 031, India. K. Sadacharam, Tuberculosis Research Centre, Mayor V. R. Ramanathan Road (Spur Tank Road), Chetpet, Chennai 600 031, India. Paul Kumaran, Tuberculosis Research Centre, Mayor V. R. Ramanathan Road (Spur Tank Road), Chetpet, Chennai 600 031, India, E-mail: ppaulkumaran{at}gmail.com. D. Rebecca Prevots, Office of Global Research, National Institute of Allergy and Infectious Diseases, 6610 Rockledge, Room 2029, National Institutes of Health, Bethesda, MD 20892, E-mail: rprevots{at}niaid.nih.gov. P. R. Narayanan, Tuberculosis Research Centre, Mayor V. R. Ramanathan Road (Spur Tank Road), Chetpet, Chennai 600 031, India, E-mail: nrparanj{at}md2.vsnl.net.in. Thomas B. Nutman, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, 4 Center Drive, Room 4/126, National Institutes of Health, Bethesda MD 20892, E-mail: tnutman{at}niaid.nih.gov. V. Kumaraswami, Tuberculosis Research Centre, Mayor V. R. Ramanathan Road (Spur Tank Road), Chetpet, Chennai 600 031, India, E-mail: kumaraswami{at}gmail.com.

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