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Epidemiologic studies of co-infection with tuberculosis (TB) and intestinal parasites in humans have not been extensively investigated in China. A cross-section study was conducted in a rural county of Henan Province, China. Pulmonary TB (PTB) case-patients receiving treatment for infection with Mycobacterium tuberculosis and healthy controls matched for geographic area, age, and sex were surveyed by using questionnaires. Fecal and blood specimens were collected for detection of intestinal parasites, routine blood examination, and infection with human immunodeficiency virus. The chi-square test was used for univariate analysis and multivariate logistic regression models were used to adjust for potential confounding factors. A total of 369 persons with PTB and 366 healthy controls were included; all participants were negative for human immunodeficiency virus. The overall prevalence of intestinal parasites in persons with PTB was 14.9%, including intestinal protozoa (7.9%) and helminthes (7.6%). The infection spectrum of intestinal parasites was Entamoeba spp. (1.4%), Blastocystis hominis (6.2%), Trichomonas hominis (0.3%), Clonorchis sinensis (0.3%), Ascaris lumbricoides (0.5%), Trichuris trichiura (2.2%), and hookworm (4.6%). The prevalence of intestinal parasites showed no significant difference between persons with PTB and healthy controls after adjusting for potential confounding factors. There was no factor that affected infection rates for intestinal parasites between the two groups. Infection with intestinal parasites of persons with PTB was associated with female sex (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.01–4.17), body mass index ≤ 19 (AOR = 3.02, 95% CI = 1.47–6.20), and anemia (AOR = 2.43, 95% CI = 1.17–5.03). Infection of healthy controls was only associated with an annual labor time in farmlands > 2 months (AOR = 4.50, 95% CI = 2.03–10.00). In addition, there was no significant trend between rates of infection with intestinal parasites and duration of receiving treatment for infection with M. tuberculosis in persons with PTB. The prevalence of intestinal parasites was not higher in persons with PTB, and there was no evidence that PTB increased susceptibility to intestinal parasites in this study. However, for patients with PTB, women and patients with comorbidities were more likely to be infected with intestinal parasites.
Authors' contributions: Xin-Xu Li, Jia-Xu Chen, Li-Xia Wang, and Xiao-Nong Zhou conceived and designed the study; Xin-Xu Li, Li-Guang Tian, Yu-Ping Zhang, Shuang-Pin Dong, Xue-Guang Hu, Jian Lu, Feng-Feng Wang, Yue Wang, Xiao-Mei Yin, Li-Jun He, Qiu-Ye Yan, Hong-Wei Zhang, and Bian-Li Xu conducted the study; Xin-Xu Li and Li-Guang Tian analyzed the data; Xin-Xu Li wrote the first draft of the manuscript; Jia-Xu Chen, Li-Xia Wang, and Bian-Li Xu provided constructive opinions and suggestions; Xiao-Nong Zhou provided strategic advice and assisted with editing of the manuscript; and all authors read and approved the final version of the manuscript.
Financial support: This study was supported by National Science and Technology Major Program (grant no. 2012ZX10004-220).
Disclosure: None of the authors have any conflicts of interest.
Authors' addresses: Xin-Xu Li, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Biology, Ministry of Health, World Health Organization Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Shanghai 200025, China, and National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China, E-mail: email@example.com. Jia-Xu Chen, Li-Guang Tian, and Xiao-Nong Zhou, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Biology, Ministry of Health, World Health Organization Collaborating Centre for Malaria, Schistosomiasis and Filariasis, Shanghai 200025, China, E-mails: firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Li-Xia Wang, National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China, E-mail: email@example.com. Yu-Ping Zhang, Shuang-Pin Dong, Xue-Guang Hu, and Jian Liu, Gushi County Center for Disease Control and Prevention, Henan Province, Gushi 465200, China, E-mails: firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Feng-Feng Wang, Yue Wang, and Xiao-Mei Yin, Anhui Province Institute of Parasitic Disease Control, Hefei 230061, China, E-mails: email@example.com, firstname.lastname@example.org, and email@example.com. Li-Jun He, Qiu-Ye Yan, Hong-Wei Zhang, and Bian-Li Xu, Henan Province Center for Disease Control and Prevention, Zhengzhou 450016, China, E-mails: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com.