Article Category:
Perspective

Intestinal Parasitic Infections May Be Overlooked Drivers of the Tuberculosis Pandemic

Lili B. Steel Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts;

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Prakash Babu Narasimhan Department of Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;

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Megha Chaudhari Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India;

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Madolyn R. Dauphinais Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts;

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Samantha Huang Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts;

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Kaley Beall Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts;

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Madeline E. Carwile Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts;

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Chelsie Cintron Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts;

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Xinyi Du Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts;

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Scott K. Heysell Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia;

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Subitha Lakshminarayanan Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;

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Urvashi B. Singh Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India;

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Pranay Sinha Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts;
Department of Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts

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DOI:
https://doi.org/10.4269/ajtmh.23-0637
Volume/Issue:
Ahead of Print
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The burden of tuberculosis (TB) is disproportionate in tropical and subtropical regions, where parasitic coinfections are common. Given the significant geographical overlap between TB and intestinal parasitic infections, it is important to consider the implications of intestinal parasitic infections for the TB pandemic. Intestinal parasitic infections have been theorized to increase vulnerability to TB by altering the inflammatory milieu, inducing undernutrition that blunts the immune response, and affecting drug pharmacokinetics. In this perspective piece, we provide a background of the epidemiological and immunological evidence that links parasitic infections to increased risk of TB progression and worse treatment outcomes. We also identify gaps in our knowledge and call for increased research on TB-parasitic coinfections to ensure action on a potentially widespread TB comorbidity.

Author Notes

Authors’ contributions: P. Sinha, M. R. Dauphinais, and L. B. Steel conceived the paper. P. Sinha, L. B. Steel, and P. B. Narasimhan developed the initial outline. L. B. Steel, P. B. Narasimhan, S. Huang, K. Beall, M. E. Carwile, C. Cintron, X. Du, S. K. Heysell, S. Lakshminarayanan, U. B. Singh and P. Sinha drafted the initial manuscript. L. B. Steel developed Figure 1. M. Chaudhari developed Figure 2. All authors contributed to the writing, editing, and revising of the manuscript.

Financial support: P. Sinha is supported by National Institutes of Health (NIH; grant number K01AI167733-01), the Warren Alpert Foundation (grant number 6005415), the Burroughs Wellcome Fund/American Society for Tropical Medicine and Hygiene, a career investment award from the Department of Medicine at the Boston University Chobanian & Avedisian School of Medicine, the Civilian Research and Development Foundation (grant number DAA3-19-65673-1), and federal funds from the Government of India’s Department of Biotechnology and the Indian Council of Medical Research. S. K. Heysell is supported by NIH/National Institute of Allergy and Infectious Diseases (award number R01 AI137080).

Current contact information: Lili B. Steel, Madolyn R. Dauphinais, Samantha Huang, Kaley Beall, Madeline E. Carwile, Chelsie Cintron, and Xinyi Du, Section of Infectious Diseases, Boston Medical Center, Boston, MA, E-mails: lbs226@cornell.edu, Madolyn.Dauphinais@bmc.org, sh5@bu.edu, kaleybeall@gmail.com, carwileme@gmail.com, Chelsie.Cintron@bmc.org, and Xinyi.Du@bmc.org. Prakash Babu Narasimhan, Department of Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, E-mail: nprakbab@gmail.com. Megha Chaudhari and Urvashi B. Singh, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India, E-mails: chaudharimegha.megha@gmail.com and drurvashi@gmail.com. Scott K. Heysell, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, E-mail: skh8r@uvahealth.org. Subitha Lakshminarayanan, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, E-mail: subitha.l@gmail.com. Pranay Sinha, Section of Infectious Diseases, Boston Medical Center, Boston, MA, and Department of Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, E-mail: psinha@bu.edu.

Address correspondence to Pranay Sinha, Crosstown Center, 801 Massachusetts Ave., Ste. 2021 A, Boston, MA 02118. E-mail: psinha@bu.edu
Copyright:
© American Society of Tropical Medicine and Hygiene 2024
Received:
12 Sep 2023
|
Accepted:
27 May 2024
|
Published Online:
13 Aug 2024
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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