Strongyloides stercoralis Coinfection Is Associated With Greater Disease Severity, Higher Bacterial Burden, and Elevated Plasma Matrix Metalloproteinases in Pulmonary Tuberculosis

• Published in: The Journal of infectious diseases 2020-08, Vol.222 (6), p.1021-1026
• Main Authors: Kumar, Nathella P, Kathamuthu, Gokul R, Moideen, Kadar, Banurekha, Vaithilingam V, Nair, Dina, Fay, Michael P, Nutman, Thomas B, Babu, Subash
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Animals; Bacteria; Biomarkers; Cavitation; Coinfection; Female; Humans; India - epidemiology; Major and Brief Reports; Male; Matrix metalloproteinase; Matrix Metalloproteinases - blood; Middle Aged; Multivariate analysis; Parasitic diseases; Plasma levels; Severity of Illness Index; Strongyloides stercoralis; Strongyloidiasis - blood; Strongyloidiasis - diagnosis; Strongyloidiasis - epidemiology; Strongyloidiasis - parasitology; Tuberculosis; Tuberculosis - blood; Tuberculosis - diagnosis; Tuberculosis - epidemiology; Tuberculosis - microbiology; Tuberculosis, Pulmonary; Young Adult
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiaa194

Abstract Background Helminths and tuberculosis (TB) largely overlap at the population level. Whether helminth infections influence disease severity and bacterial burdens in TB is not well understood. Methods This study was conducted to examine the disease severity in a cohort of pulmonary TB (PTB) individuals with (Ss+) or without (Ss−) seropositivity for Strongyloides stercoralis infection. Results Ss+ was associated with increased risk of cavitation (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.33–9.04; P < .0001) and bilateral lung involvement (OR, 5.97; 95% CI, 3.03–12.09; P < .0001) in PTB individuals. Ss+ was also associated with higher bacterial burdens (OR, 7.57; 95% CI, 4.18–14.05; P < .0001) in PTB individuals. After multivariate analysis adjusting for covariates, Ss+ was still associated with greater risk of cavitation (adjusted OR [aOR], 3.99; 95% CI, 1.73–9.19; P = .0014), bilateral lung involvement (aOR, 4.09; 95% CI, 1.78–9.41; P = .0011), and higher bacterial burden (aOR, 9.32; 95% CI, 6.30–13.96; P < .0001). Finally, Ss+ was also associated with higher plasma levels of matrix metalloproteinases ([MMP]-1, -2, -7, -8, and -9) in PTB individuals. Conclusions Therefore, our data demonstrate that coexistent Ss infection is associated with greater disease severity and higher bacterial burden in PTB. Our data also demonstrate enhanced plasma levels of MMPs in coinfected individuals, suggesting a plausible biological mechanism for these effects. This study demonstrates that Strongyloides stercoralis coinfection is associated with increased disease severity and elevated mycobacterial burdens in adult pulmonary tuberculosis. This is also associated with heightened levels of MMPs in the coinfected individuals.