Usually, a small worm burden has limited or no pathology and may be commensal to the host. Most helminth parasites are large, long-lived organisms, and mostly they are not able to replicate within their human host.
Due to these features, antigenic variation and sequestration in specialized niches are not feasible for helminths to escape from the host defense. Immune regulation, in this case, refers to the capacity of helminths to limit the excessive host immune response directed toward themselves.
During long-standing chronic infection, helminths elicit limited inflammation in invaded tissues and install an immunoregulatory environment that ensures their survival. On the one hand, it helps helminths to remain unrecognized in human tissues and protects them from being eradicated.
On the other hand, the host is protected from excessive immune responses that may result in organ damage. Immunoregulation during helminth infections is induced by helminth-derived products, which can be either parasite secretions, excretions, proteins, or extracellular vesicles that constantly interact with the host immune system. It is well documented that the host—parasite interactions during worm infection cause the immune system to mount a type 2 response. Nevertheless, helminth-induced immune regulation may result in both beneficial and detrimental outcomes.
COVID pathology is mediated by an overreaction of the host immune system cytokine storm. These metabolic diseases are characterized by increased levels of proinflammatory cytokines. In this case, helminth-induced immunoregulation will help to modulate COVIDinduced inflammation and the interaction of helminth and COVID coinfections may perhaps be beneficial for the patient.
The beneficial interactions during helminth co-infections have been shown in previous reports. As reviewed in, 49 individuals with worm infections are less likely to have metabolic dysfunctions as compared to those without helminth infections.
Rajamanickam and colleagues also reported that type 2 diabetes patients with concomitant helminth infections had reduced levels of proinflammatory cytokines and, this effect was reversed following treatment of the helminth infection. Besides, a previous study on mice coinfected with Heligmosomoides polygyrus bakeri H.
A recent data by Gebrecherkos et al 53 from Ethiopia reported that Interestingly in the same study, COVID patients with helminth co-infections were less likely to have non-communicable diseases NCDs , including hypertension, cardiovascular diseases, and diabetes. Hays et al 2 also believe that chronic worm infections may protect COVID patients from the severe pathological responses.
Instead, it is a normal regulatory and tissue-repair response to viral-induced inflammation. There are some helminth endemic areas that have been heavily affected by the pandemic. Indeed, previous pieces of evidence on viral infections reported that helminth co-infections may have detrimental clinical outcomes. On the one hand, the development of Treg and IL production induced by helminths will impair the host immune responses, which in turn increases host susceptibility to microbial infections.
A systematic review by Abdoli et al 63 projected that preexisting helminth infections may suppress the efficient immune response against SARS-CoV-2 in the early stage of the infection, and thereby may increase the morbidity and mortality of COVID Aside from their role of immune interaction, Paniz-Mondolfi et al showed a different perspective in which the increased severity and mortality of COVID in helminth endemic areas may be attributed to the nutritional and metabolic compromises caused by worm infections.
In parasite endemic regions, the management of helminth co-infections on COVID patients remains controversial. COVID and helminth co-infection may be a common phenomenon in low- and middle-income countries. However, their interaction is not yet well studied and understood enough. We are not certain whether treating helminth co-infections on COVID patients will be beneficial or detrimental.
There is therefore a need for prospective studies to examine the clinical and immunological perspectives of COVID patients with helminth co-infections. The findings of such studies will be very important as they will determine the management of COVID in areas where helminth infections are co-endemic.
As the world is facing the third wave of the pandemic, understanding the interaction of helminth co-infections would clearly be of great interest. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
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