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Background: An observational study has suggested that relapsing–remitting multiple sclerosis patients with helminth infections have lower disease activity and progression than uninfected multiple sclerosis patients. Objective: To evaluate the safety and efficacy on MRI activity of treatment with TSO in relapsing MS. Methods: The study was an open-label, magnetic resonance imaging assessor-blinded, baseline-to-treatment study including ten patients with relapsing forms of multiple sclerosis. Median (range) age was 41 (24–55) years, disease duration 9 (4–34) years, Expanded Disability Status Scale score 2.5 (1–5.0), and number of relapses within the last two years 3 (2–5). Four patients received no disease modifying therapy, while six patients received IFN-β. After an observational period of 8 weeks, patients received 2500 ova from the helminth Trichuris suis orally every second week for 12 weeks. Patients were followed with serial magnetic resonance imaging, neurological examinations, laboratory safety tests and expression of immunological biomarker genes. Results: Treatment with Trichuris suis orally was well-tolerated apart from some gastrointestinal symptoms. Magnetic resonance imaging revealed 6 new or enlarged T2 lesions in the run-in period, 7 lesions in the early period and 21 lesions in the late treatment period. Two patients suffered a relapse before treatment and two during treatment. Eight patients developed eosinophilia. The expression of cytokines and transcription factors did not change. Conclusions: In a small group of relapsing multiple sclerosis patients, Trichuris suis oral therapy was well tolerated but without beneficial effect.

Helminth infection is common in malaria endemic areas, and an interaction between the two would be of considerable public health importance. Animal models suggest that helminth infections may increase susceptibility to malaria, but epidemiological data has been limited and contradictory. In a vaccine trial, we studied 387 one- to six-year-old children for the effect of helminth infections on febrile Plasmodium falciparum malaria episodes. Gastrointestinal helminth infection and eosinophilia were prevalent (25% and 50% respectively), but did not influence susceptibility to malaria. Hazard ratios were 1 for gastrointestinal helminth infection (95% CI 0.6-1.6) and 0.85 and 0.85 for mild and marked eosinophilia, respectively (95% CI 0.56-1.76 and 0.69-1.96). Incident rate ratios for multiple episodes were 0.83 for gastro-intestinal helminth infection (95% CI 0.5-1.33) and 0.86 and 0.98 for mild and marked eosinophilia (95% CI 0.5-1.4 and 0.6-1.5). There was no evidence that infection with gastrointestinal helminths or urinary schistosomiasis increased susceptibility to Plasmodium falciparum malaria in this study. Larger studies including populations with a greater prevalence of helminth infection should be undertaken.

Eosinophils are effectors in immunity to tissue helminths but also induce allergic immunopathology. Mechanisms of eosinophilia in non-mucosal tissues during infection remain unresolved. Here we identify a pivotal function of tissue macrophages (Mϕ) in eosinophil anti-helminth immunity using a BALB/c mouse intra-peritoneal Brugia malayi filarial infection model. Eosinophilia, via C-C motif chemokine receptor (CCR)3, was necessary for immunity as CCR3 and eosinophil impairments rendered mice susceptible to chronic filarial infection. Post-infection, peritoneal Mϕ populations proliferated and became alternatively-activated (AAMϕ). Filarial AAMϕ development required adaptive immunity and interleukin-4 receptor-alpha. Depletion of Mϕ prior to infection suppressed eosinophilia and facilitated worm survival. Add back of filarial AAMϕ in Mϕ-depleted mice recapitulated a vigorous eosinophilia. Transfer of filarial AAMϕ into Severe-Combined Immune Deficient mice mediated immunological resistance in an eosinophil-dependent manner. Exogenous IL-4 delivery recapitulated tissue AAMϕ expansions, sustained eosinophilia and mediated immunological resistance in Mϕ-intact SCID mice. Co-culturing Brugia with filarial AAMϕ and/or filarial-recruited eosinophils confirmed eosinophils as the larvicidal cell type. Our data demonstrates that IL-4/IL-4Rα activated AAMϕ orchestrate eosinophil immunity to filarial tissue helminth infection.

Strongyloides stercoralis infection, a neglected tropical disease, is widely distributed. Autochthonous cases have been described in Spain, probably infected long time ago. In recent years the number of diagnosed cases has increased due to the growing number of immigrants, travelers and refugees, but endemically acquired cases in Spain remains undetermined. We systematically searched the literature for references on endemic strongyloidiasis cases in Spain. The articles were required to describe Strongyloides stercoralis infection in at least one Spanish-born person without a history of travel to endemic areas and be published before 31st May 2018. Epidemiological data from patients was collected and described individually as well as risk factors to acquisition of the infection, diagnostic technique that lead to the diagnosis, presence of eosinophilia and clinical symptoms at diagnosis. Thirty-six studies were included, describing a total of 1083 patients with an average age of 68.3 years diagnosed with endemic strongyloidiasis in Spain. The vast majority of the cases were described in the province of Valencia (n = 1049). Two hundred and eight of the 251 (82.9%) patients in whom gender was reported were male, and most of them had current or past dedication to agriculture. Seventy percent had some kind of comorbidity. A decreasing trend in the diagnosed cases per year is observed from the end of last decade. However, there are still nefigw diagnoses of autochthonous cases of strongyloidiasis in Spain every year. With the data provided by this review it is likely that in Spain strongyloidiasis might have been underestimated. It is highly probable that the infection remains undiagnosed in many cases due to low clinical suspicion among Spanish population without recent travel history in which the contagion probably took place decades ago.

Strongyloidiasis, a disease caused by Strongyloides stercoralis ( S. stercoralis ) nematode, can present in acute, chronic, hyperinfection, and disseminated forms. It is of particular important due to its high mortality rate, especially among immunocompromised patients, and the absence of a gold standard diagnostic method. Eosinophilia, as a key sign, can help in the diagnosis of the infection. This report presents five cases of strongyloidiasis who referred to the 17 Shahrivar Hospital, Abadan County, Iran, for various reasons, including cardiovascular diseases, elective surgeries, and routine health check-ups. Persistent eosinophilia and intermittent gastrointestinal and respiratory symptoms in their medical histories raised suspicion of an intestinal infection. S. stercoralis detection was performed by Enzyme Linked Immunosorbent Assay (ELISA), direct microscopy examination, and agar plate culture (APC). While all cases exhibited elevated IgG titers, S. stercoralis larvae were detected by direct microscopy examination in two cases (later confirmed by APC), and three additional cases, despite being microscopy-negative, tested positive through APC. Two patients were also infected with Giardia intestinalis , which one of them had Blastocystis hominis as well. Eosinophilia, can help identify parasitic infections, but its nonspecificity requires careful evaluation of the patient’s medical history. In three of the cases, the final diagnosis was obtained using serial stool examination and APC. Thus, considering eosinophilia, the best strategy for optimal diagnosis of this infection involves combining serological and coprological methods along with identifying risk factors.

Elimination of the helminth disease, river blindness, remains challenging due to ivermectin treatment-associated adverse reactions in loiasis co-infected patients. Here, we address a deficit in preclinical research tools for filarial translational research by developing Loa loa mouse infection models. We demonstrate that adult Loa loa worms in subcutaneous tissues, circulating microfilariae (mf) and presence of filarial biomarkers in sera occur following experimental infections of lymphopenic mice deficient in interleukin (IL)-2/7 gamma-chain signaling. A microfilaraemic infection model is also achievable, utilizing immune-competent or -deficient mice infused with purified Loa mf. Ivermectin but not benzimidazole treatments induce rapid decline (>90%) in parasitaemias in microfilaraemic mice. We identify up-regulation of inflammatory markers associated with allergic type-2 immune responses and eosinophilia post-ivermectin treatment. Thus, we provide validation of murine research models to identify loiasis biomarkers, to counter-screen candidate river blindness cures and to interrogate the inflammatory etiology of loiasis ivermectin-associated adverse reactions. Here, the authors develop a mouse model of Loa loa that reflects human infections, including eosinophilia, and determine effects of ivermectin treatment.

6 years after his initial presentation, the patient attended a regional ophthalmology centre complaining of red, irritated right eye with a worm moving around in it. On examination he was systemically well but had a subconjunctival worm moving about in his right eye. The worm was removed under local anaesthetic with forceps. A random microfilaria count of the patient's serum was 1500 microfilaria per mL; the eosinophil count at that time was 2·0 × 109 per L and he was referred to our tropical medicine hospital (figure; video). Exploration of his travel history found that, 7 years earlier, he had spent 3 months in Ilesa—a state in the southwest of Nigeria. The patient said he lived alongside a local family in a traditional hut and visited forested national parks nearby.

Angiostrongylus cantonensis (rat lungworm), a parasitic nematode, is expanding its distribution. Human infection, known as angiostrongyliasis, may manifest as eosinophilic meningitis, an emerging infectious disease. The range and incidence of this disease are expanding throughout the tropics and subtropics. Recently, the Hawaiian Islands have experienced an increase in reported cases. This study addresses factors affecting the parasite's distribution and projects its potential future distribution, using Hawaii as a model for its global expansion. Specimens of 37 snail species from the Hawaiian Islands were screened for the parasite using PCR. It was present on five of the six largest islands. The data were used to generate habitat suitability models for A. cantonensis, based on temperature and precipitation, to predict its potential further spread within the archipelago. The best current climate model predicted suitable habitat on all islands, with greater suitability in regions with higher precipitation and temperatures. Projections under climate change (to 2100) indicated increased suitability in regions with estimated increased precipitation and temperatures, suitable habitat occurring increasingly at higher elevations. Analogously, climate change could facilitate the spread of A. cantonensis from its current tropical/subtropical range into more temperate regions of the world, as is beginning to be seen in the continental USA.

Background Strongyloides stercoralis is a pathogenic nematode affecting the human intestine. Chronic strongyloidiasis often remains asymptomatic, posing diagnostic challenges due to the low sensitivity of conventional methods. Using traditional methods, this study investigated the prevalence of strongyloidiasis in Khuzestan Province, southwestern Iran. We also studied the effectiveness of a Strongyloides immunoglobulin G4 (IgG4) rapid diagnostic test (RDT) for timely infection detection before and after treatment. Methods This cross-sectional study, conducted during 2022–2024, evaluated 520 participants with eosinophilia (> 5%) for S. stercoralis infection. Coprological methods used were direct smear stool microscopy and agar plate culture. Serological methods were enzyme-linked immunosorbent assay (ELISA) (NovaTec ® kit) and a prototype IgG4 RDT using a recombinant antigen (NIE) . Traditional coprology and composite references were used to assess the diagnostic power. Among copro-positive patients, 30 cases were followed up at least 3 months after treatment using the same methods. Results Of the 373 participants who submitted stool samples, coprological methods identified 95 positive cases, with culture proving to be more sensitive than direct smear (24.9%, 93/373 versus 7.5%, 28/373). Of the 520 participants, 35.2% (183/520) and 43.7% (227/520) tested positive for S. stercoralis using ELISA and IgG4 RDT, respectively. Spearman’s rank correlation between the IgG4 RDT and ELISA was significant ( ρ  = 0.772; P  < 0.001). Despite minor discrepancies, the IgG4 RDT showed substantial agreement with the ELISA ( κ  = 0.776). Increased eosinophil counts were strongly associated with Strongyloides infection with a mean of 20.48% in copro-positives versus 15.22 in copro-negatives and area under the curve (AUC) of 0.741 and 0.701 for coprology and the combination of coprology and serology methods (CRS), respectively. In the 30 follow-up patients, a significant reduction in eosinophil counts ( P  < 0.001) was observed. Five cases (17%) remained larva-positive, and serological tests significantly increased readings/scores. Three copro-negative patients showed strong positive results on ELISA and IgG4 RDT. Conclusions On the basis of the obtained results, the prevalence of S. stercoralis infection among the eosinophilic population was high. This study showed that the IgG4 RDT is a reliable and efficient diagnostic tool for S. stercoralis infection. The rapid test results demonstrated significant agreement with the ELISA and effectively detected infection in eosinophilic patients, making it a suitable diagnostic test for screening, particularly in resource-limited settings. Graphical Abstract