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Background  In sub-Saharan Africa poly-parasite infections are frequently observed in children, and with poly-parasitism modulating immune mechanisms, mediated by cytokines and chemokines, are required to prevent overwhelming inflammation and host tissue damage. We analyzed in children co-infected with helminthes and protozoan parasites their cellular production of regulatory and pro-inflammatory cytokines and chemokines in response to parasite antigens and allergens.    Methods  Intestinal and intravascular parasite infections were detected in stool and urines samples. The  in vitro  cellular cytokine and chemokine responses of peripheral blood mononuclear cells (PBMC) to parasite antigens and allergens were analysed in children (n = 87) with single and poly-parasite infection, and skin prick test reactivity to fungus and mite allergens was determined in singly and poly-parasitized children (n = 509).    Results  In children  Entamoeba histolytica/dispar  (62%),  Necator americanus  (31%),  Schistosoma haematobium  (28%),  S. mansoni  (21%),  Hymenolepis nana  (2%) and  Strongyloides stercoralis  (1%) were diagnosed. Singly infected were 37%, 47% were positive for 2 or more parasite species and 16% were infection-free. When PBMC were stimulated  in vitro  with parasite antigens and allergens, regulatory-type cytokine IL-27 and alarmin-type IL-33 enhanced with poly-parasite infections whilst IL-10 and pro-inflammatory MIP3-α/CCL20 and MIG/CXCL9 were produced in similar amounts in singly or poly-parasitized children. The co-stimulation  in vitro  of PBMC with mite allergens and  Ascaris lumbricoides  antigens depressed the allergen-induced pro-inflammatory IL-27, IL-33 and MIP3-α/CCL20 responses while regulatory IL-10 remained unaffected. Post albendazole and/or praziquantel treatment, the cellular release of IL-10, IL-33, MIP3-α/CCL20 and MIG/CXCL9 lessened significantly in all children infection groups. Skin prick test (SPT) reactivity to fungus  Aspergillus fumigatus  and mite  Dermatophagoides pteronyssinus  allergens was investigated in 509 children, and positive SPT responses were found in 23% of the infection-free, and in 47%, 53% and 56% of the singly, doubly and poly-parasite infected, respectively.    Conclusions  In children co-infected with helminthes and protozoan parasites a mixed cellular response profile of both inflammatory and regulatory chemokines and cytokines was stimulated by individual antigens and allergens, pro-inflammatory cytokines and chemokines enhanced with an increasing number of parasite infections, and in poly-parasitized children skin prick test reactivity to allergens extracts was highest.

journal of inflammation

Cellular cytokine and chemokine responses to parasite antigens and fungus and mite allergens in children co-infected with helminthes and protozoa parasites