Malnutrition and Infection: Complex Mechanisms and Global Impacts

Schaible, Ulrich E.; Kaufmann, Stefan H. E.

doi:10.1371/journal.pmed.0040115

Cited by 751 publications

(645 citation statements)

References 70 publications

(76 reference statements)

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“…HIV can also impair lymphocyte functions against malaria infection [61]. Similarly, malnutrition can lead to atrophy of the thymus, leucopenia, and diminished functional T cells that hamper protective immunity to malaria [62]. …”

mentioning

confidence: 99%

Malaria Parasites in the Asymptomatic: Looking for the Hay in the Haystack

Galatas

Bassat

Mayor

2016

Trends in Parasitology

116

122

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With malaria elimination back on the international agenda, programs face the challenge of targeting all Plasmodium infections, not only symptomatic cases. As asymptomatic individuals are unlikely to seek treatment, they are missed by passive surveillance while remaining infectious to mosquitoes, thus acting as silent reservoirs of transmission. To estimate the risk of asymptomatic infections in various phases of malaria elimination, we need a deeper understanding of the underlying mechanisms favoring carriage over disease, which may involve both pathogen and host factors. Here we review our current knowledge on the determinants leading to Plasmodium falciparum symptomless infections. Understanding the host-pathogen interactions that are most likely to affect transitions between malaria disease states could guide the development of tools to tackle asymptomatic carriers in elimination settings. Being AsymptomaticPeaceful coexistence with the infected host, rarely causing clinical symptoms, is a common but poorly understood phenomenon that occurs for many human pathogens [1]. Because such asymptomatic cases of infection occur without eventual overt symptoms, they do not come to clinical attention, thus representing a large hidden reservoir of active infection that permits their persistence and eventual spread to other human hosts. This is the case for many malaria infections in semi-immune individuals from endemic areas, which commonly cause a mild febrile illness or no apparent symptoms at all, while keeping parasite numbers at low densities [2] (Box 1).Carriage of asymptomatic malaria (see Glossary) infections, being at the same time difficult to detect and to manage, has considerable implications for the design and use of malaria elimination strategies. Symptomless infections that persist during the dry season in areas of seasonal transmission have been suggested to seed the malaria outbreaks after annual rains when mosquitoes reappear [3]. Similarly, asymptomatic parasitemia may potentially contribute to persistence of transmission in low-transmission settings [4]. However, the precise contribution of asymptomatic malaria to transmission in areas that have achieved substantial reductions in the malaria burden remains a matter of debate [5], as is the assumption that detecting and targeting these individuals for radical treatment, as opposed to using mass drug administration approaches, would be an efficient and effective tactic. Moreover, eradication in Europe, North America, and other parts of the world using no better diagnostics than microscopy [6] suggest that key determinants of success might not be finding the last parasite. From a practical point of view, the proportion of asymptomatic infections in certain situations and phases of malaria elimination may impose the need for modifications of detection methods (active versus passive case detection) [7] if, for example, symptom-based surveillance at health facilities is insufficient and mass blood surveys are necessary to inform the design of elimination i...

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mentioning

confidence: 99%

Malaria Parasites in the Asymptomatic: Looking for the Hay in the Haystack

Galatas

Bassat

Mayor

2016

Trends in Parasitology

116

122

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“…8,10,16,17 In both incidence and the rate of development into more serious infections, a relation has also been established between upper respiratory tract infections and malnutrition. 7,9,18 For the specific factor of growth rate, some studies have shown a relationship between growth faltering and gastroenteritis. [11][12][13] A combined analysis of data from nine studies in five countries (Bangladesh, Brazil, Ghana, Guinea-Bissau and Peru) shows that 25% of stunting at 24 months of age was associated with five or more episodes of gastroeneteritis in the first 2 years of life.…”

Section: Relationship Between Weight Gain and Infectionmentioning

confidence: 99%

“…1,2 When an infection happens, the immune system needs various nutrients to maintain immunity against pathogens. Various hypothesis has said that frequent infections may make nutritional interventions may not as effective.…”

Section: Introductionmentioning

confidence: 99%

“…6 Association between malnutrition, immunodeficiency, incidence of infections and morbidity in children has been shown by various studies. [7][8][9][10] However, few studies have tried to link the problem of growth rate itself with the prevalence of different types of infection beside gastroenteritis. [11][12][13] A province in the eastern Indonesia, West Papua, hold the distinction of having the lowest population density in Indonesia.…”

Section: Introductionmentioning

confidence: 99%

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Relationship Between Growth Rate and Different Types of Infection in Children Under 5 Years on West Papua

Pratomo

2017

IJTID

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“…7 The association between TB and DM occur in low-and medium-income countries, where roughly 95% of patients with TB and 70% of patients with DM live. 8 Patients with DM are at twice the risk of acquiring TB compared to those without DM, and that this association is even stronger in HIV positive subjects. 9 Moreover, DM patients with smearpositive pulmonary TB have a higher probability of failure of the sputum smear conversion after 2 months of therapy than patients without DM.…”

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confidence: 96%

An Observational Study to Determine the Impact of Glycaemic Control on Presentation of Drug Sensitive and Drug Resistant Pulmonary Tb in Type 2 Diabetes

Mahmood¹,

Verma²,

Ahmad³

et al. 2018

jemds

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BACKGROUND There is a strong correlation between the two diseases, diabetes and tuberculosis, with impact of one on the other. Poor glycaemic control causes poor outcome of tuberculosis treatment and that can be observed radiologically and microbiologically beside clinical observation.The aim of the study is to study the impact of glycemic control on presentation (clinical, radiological and microbiological) of drug sensitive and drug resistant pulmonary TB in type 2 diabetes. MATERIALS AND METHODSThis is an observational cross-sectional study. Patients above 18 years, having PTB with DM over one year were included. PTB with other conditions like HIV, Pregnancy, Connective tissue disorders, Chronic renal failure, Chronic liver disease, Malignancy, on longterm steroid use or cytotoxic drug therapy or on immunosuppressive drugs were not included in this study. Glycemic control was assessed by A1c < 7 as controlled and > 7 as uncontrolled. Clinical, Microbiological and Radiographic parameters of the patients were studied in respect to their glycemic control. RESULTS263 PTB patients who were screened for the study, out of which 94 were diabetic. The prevalence of D Min PTB patients was found to be 35.7% (out of 180 drug-sensitive PTB patients 68 were diabetic and out of 83 drug resistant PTB patients 26 were diabetic). The overall mean age was (50 ± 9) years, maximum no. of patients (60%) were in 40 -60 years' age group, 70% males with mean A1c (8.54 ± 0.03), 81% had uncontrolled glycemic status and 100% had cough with mean A1c (8.47 ± 0.03). 81% were sputum AFB positive with mean A1c (8.64 ± 0.014), 75.5% had lower lung field abnormalities with mean A1c (8.61 ± 0.094), 12.57% upper lung field with mean A1c (7.53 ± 0.012), 9.5% both lung fields with mean A1c (9.19 ± 0.082), 84% had infiltrative lesions with mean A1c (8.45 ± 0.017) and 25.5% had cavities with high mean A1c (10.04 ± 0.029). CONCLUSIONThe association between DM and TB is the most emerging challenge for global TB control. Poor glycemic control has significant effect on sputum smear positivity, more cavity formation and lower lung field involvement with no effect on clinical symptom. Hence, with the help of this study, it can be concluded that screening for DM should be performed routinely in patients with TB that may improve treatment outcomes. Submission 30-12-2017, Peer Review 27-01-2018, Acceptance 01-02-2018, Published 12-02-2018. Corresponding Author: Dr. Tariq Mahmood, Professor and HOD, Department of Pulmonary Medicine, MLN Medical College, Allahabad-211001, Uttar Pradesh, India. E-mail: mlnmctariqmahmood@gmail.com DOI: 10.14260/jemds/2018 An estimated 10.4 million people fell ill with TB in 2016: 90% were adults, 65% were male, 10% were people living with HIV (74% in Africa) and 56% were in five countries: India, Indonesia, China, the Philippines and Pakistan. Drugresistant TB is a continuing threat to world community. In 2016, there were 6 lakh new cases with resistance to rifampicin, the most effective first-line drug, of whi...

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Malnutrition and Infection: Complex Mechanisms and Global Impacts

Abstract: The authors discuss current concepts and controversies surrounding the complex influences of malnutrition on infection and immunity, and point to practical consequences of countermeasures in acute malnutrition.

Cited by 751 publications

References 70 publications

Malaria Parasites in the Asymptomatic: Looking for the Hay in the Haystack

Malaria Parasites in the Asymptomatic: Looking for the Hay in the Haystack

Relationship Between Growth Rate and Different Types of Infection in Children Under 5 Years on West Papua

An Observational Study to Determine the Impact of Glycaemic Control on Presentation of Drug Sensitive and Drug Resistant Pulmonary Tb in Type 2 Diabetes

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