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Plasma proteins in children with trichuris dysentery syndrome
E S Cooper1, D D Ramdath, C Whyte-Alleng
1Tropical Metabolism Research Unit, University of the West Indies, Kingston, Jamaica, West Indies.
Insights
Children with Trichuris trichiura dysentery show an acute phase response, including elevated fibronectin. Plasma viscosity remains high post-treatment, indicating persistent inflammation in trichuriasis.
Area of Science:
- Clinical immunology
- Parasitology
- Pediatric infectious diseases
Background:
- Trichuris trichiura infection, particularly dysentery syndrome (TDS), can cause significant health issues in children.
- Understanding the systemic inflammatory response and plasma protein changes is crucial for managing TDS.
Purpose of the Study:
- To investigate the systemic inflammatory response in children with Trichuris trichiura dysentery syndrome (TDS).
- To characterize specific plasma protein disturbances in TDS compared to uninfected children within an endemic area.
Main Methods:
- A cross-sectional study compared 53 children with TDS, 16 disease controls (DC), and 20 normal controls (NC).
- Plasma levels of acute phase proteins (CRP, AAT, caeruloplasmin, albumin, globulin, fibrinogen, fibronectin, ferritin, transferrin) and plasma viscosity were measured.
- Plasma viscosity was serially measured in TDS cases over six months.
Main Results:
- TDS children exhibited significantly higher levels of C-reactive protein, alpha-1-antitrypsin, total globulin, fibronectin, and plasma viscosity compared to normal controls.
- Disease controls also showed acute phase protein elevations, but increased caeruloplasmin was specific to this group.
- An elevation in fibronectin was specific to the TDS group, and plasma viscosity remained elevated six months post-treatment.
Conclusions:
- Intense Trichuris trichiura infection triggers an acute phase response.
- Elevated plasma fibronectin is a specific marker in TDS.
- Plasma viscosity remains abnormally high for at least six months after treatment in TDS patients.
Aims:
To determine whether in Trichuris trichiura dysentery there is (1) evidence of a systemic inflammatory response, (2) evidence that the plasma protein disturbance has special characteristics compared with uninfected children in the endemic environment.
Methods:
Three groups of children (age 1.6 to 11.4 years) were studied: 53 cases of trichuris dysentery syndrome (TDS), 16 cases of chronic non-secretory diarrhoea not infected with the parasite ("disease controls", DC), and 20 asymptomatic, parasite-free primary schoolchildren (normal controls, NC). C reactive protein, alpha 1 antitrypsin, caeruloplasmin, albumin, total globulin, fibrinogen, fibronectin, ferritin, and transferrin were measured on a single occasion for each. The study was thus a cross sectional descriptive survey for group comparison. Plasma viscosity was measured on admission for TDS and DC and repeated after six weeks and six months for TDS.
Results:
Plasma C reactive protein, alpha 1 antitrypsin, total globulin, fibronectin, and viscosity were significantly higher in TDS than in NC. DC children also had acute phase protein elevations (C reactive protein, caeruloplasmin, viscosity). However, the increase in caeruloplasmin was specific to the DC group while an increase in fibronectin was specific to the TDS group. Serial measurement of viscosity in TDS showed a modest but significant fall during the six months following treatment.
Conclusions:
There is an acute phase response in intense trichuriasis and a specific elevation of plasma fibronectin. Plasma viscosity remains abnormally high six months after treatment, although lower than at diagnosis.