Maternal Intestinal Helminth Infection and Its Impact on the Neonatal and Maternal Humoral Immune Response to MTB infection: A Study at Hana Maryam Health Center Addis Ababa, Ethiopia

Abstract

Abstract M. tuberculosis (MTB) and helminth Infections are the major health problems that are mostly found in unprivileged and underdeveloped areas of the world where both infections can co exist. Helminth infection during pregnancy has an immunological effect on both the fetus and the maternal immune system. However, there exists limited data in Ethiopia, regarding the effect of maternal helminth infection on neonate immunity to MTB infection. In the present study, we hypothesized that neonates that are born to a helminth-infected mother have distinct humoral immunity than neonates from an uninfected mother. Objectives: The present study aims to investigate maternal intestinal helminth infection and its impact on the neonatal and maternal humoral immune response to MTB infection Methods: This study is a comparative cross-sectional study as part of an ongoing longitudinal cohort study working on innate immunity. A purposive sampling technique was used to select 75 study participants. Study-specific case report forms (CRF) were used to collect participant’s socio-demographic, physical, and clinical information. Stool and venous blood samples were collected from eligible pregnant mothers at baseline and cord blood samples during delivery. Wet mount and Kato Katz stool examinations were performed to identify those with intestinal helminth infection. Plasma samples were analyzed for immunological parameters profiling of both the mother and neonates using ELISA. Mycobacterial culture filtrate protein (CFP) antigen-specific maternal and neonatal IgG antibodies and total IgE levels of neonates were measured. Non-parametric tests including Mann-Whitney U tests, and Spearman correlation were used for data analysis a P-value less than 0.05 was considered statistically significant. Result: From purposively selected study participants of 33 helminth-infected mothers the predominant parasites identified were Tania Spp 12/33 (36%) and Hookworm 11/33 (33.3%). Of the 75 QFT tested participants’ only 10 (13.3%) were QFT+ve and a significant number of 5(6.7%) were indeterminate results. Elevated plasma IgG levels were observed among QFT positive mothers and no significant difference was observed among helminth-infected and non-infected groups. An increased plasma IgE level was observed in neonates born to helminth-infected mothers (P=0.03). Similarly, elevated IgE was also observed among neonates from QFT-negative mothers (P=0.02). However, an increased IgG level was observed among neonates from QFT-positive mothers (P=0.04) regardless of the helminth infection status of the mother. Conclusion: The current finding showed maternal helminthic infection impacts the neonatal humoral immune response. An elevated total IgE was observed among neonates that were born to a helminth-infected mother. This showed maternal helminth infection affects neonatal IgE antibody levels, which could be due to an in-utero sensitization to helminth antigens. Neonates born from mothers with positive QFT tests have higher mycobacterial CFP antigen specific IgG levels regardless of helminth infection status. Recommendation: The study showed the impact of helminthic infection on neonatal humoral immunity response to MTB infection but further study should be initiated with a larger sample size to address the magnitude of the impact. Keywords: Helminth infection, cord blood, pregnancy, neonates, in-utero priming, MTB