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Re-Visiting Trichuris trichiura Intensity Thresholds Based on Anemia during Pregnancy
Open accessAbstract
BACKGROUND: The intensity categories, or thresholds, currently used for Trichuris trichiura (ie. epg intensities of 1-999 (light); 1,000-9,999 epg (moderate), and ≥ 10,000 epg (heavy)) were developed in the 1980s, when there were little epidemiological data available on dose-response relationships. This study was undertaken to determine a threshold for T. trichiura-associated anemia in pregnant women and to describe the implications of this threshold in terms of the need for primary prevention and chemotherapeutic interventions. METHODOLOGY/PRINCIPAL FINDINGS: In Iquitos, Peru, 935 pregnant women were tested for T. trichiura infection in their second trimester of pregnancy; were given daily iron supplements throughout their pregnancy; and had their blood hemoglobin levels measured in their third trimester of pregnancy. Women in the highest two T. trichiura intensity quintiles (601-1632 epg and ≥ 1633 epg) had significantly lower mean hemoglobin concentrations than the lowest quintile (0-24 epg). They also had a statistically significantly higher risk of anemia, with adjusted odds ratios of 1.67 (95% CI: 1.02, 2.62) and 1.73 (95% CI: 1.09, 2.74), respectively. CONCLUSIONS/SIGNIFICANCE: This analysis provides support for categorizing a T. trichiura infection ≥ 1,000 epg as 'moderate', as currently defined by the World Health Organization. Because this 'moderate' level of T. trichiura infection was found to be a significant risk factor for anemia in pregnant women, the intensity of Trichuris infection deemed to cause or aggravate anemia should no longer be restricted to the 'heavy' intensity category. It should now include both 'heavy' and 'moderate' intensities of Trichuris infection. Evidence-based deworming strategies targeting pregnant women or populations where anemia is of concern should be updated accordingly.
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“T. trichiuris infection has also been linked to anaemia and ineffective iron supplementation.”
From Intestinal Parasitic Infection and Nutritional Status in Children under Five Years Old: A Systematic Review (2022) · cites this paper as [71]
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Metadata
- Authors
- Gyorkos, T. W., Gilbert, N. L., Larocque, R., Casapía, M., & Montresor, A.
- Affiliations
- McGill University Health Centre (CA)
- International Development Research Centre (CA)
- World Health Organization (CH)
- Corresponding author
- Gyorkos, Theresa W.
- Venue
- PLoS Neglected Tropical Diseases
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-09-13
- Volume
- 6
- Issue
- 9
- Pages
- e1783
- ISSN
- 1935-2727 (ISSN-L)
- 1935-2735
- PMC
- PMC3441397
- OpenAlex
- W1966101023
- Cited by
- 22
- References
- 23
- Citations by year
- 2024: 2 · 2022: 4 · 2021: 4 · 2019: 1 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 3 · 2013: 1
- FWCI
- 1.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS neglected tropical diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship@McGill (McGill) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- McGill University
- McGill University Health Centre
- Canadian Institutes of Health Research
- Topics
- Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
- Health Sciences › Medicine › Infectious Diseases › Parasitic Diseases Research and Treatment
- Life Sciences › Immunology and Microbiology › Parasitology › Helminth infection and control
- Keywords
- Trichuris trichiura, trichuriasis, anemia in pregnancy, hemoglobin, dose-response relationship, iron supplementation, anthelmintic treatment, primary prevention, Iquitos
- MeSH terms
- Anemia, Animals, Blood Chemical Analysis, Female, Hemoglobins, Humans, Peru, Pregnancy, Severity of Illness Index, Trichuriasis, Trichuris, Pregnancy Complications, Parasitic
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