Helminth infection and metabolic disease: Strongyloides stercoralis infection and type 2 diabetes mellitus in an Aboriginal community
Hays, Russell John (2018) Helminth infection and metabolic disease: Strongyloides stercoralis infection and type 2 diabetes mellitus in an Aboriginal community. PhD thesis, James Cook University.
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Abstract
Recent years have seen an upsurge in interest in the relationship between helminth infections and metabolic diseases such as insulin resistance and type 2 diabetes mellitus (T2DM). Limited clinical and laboratory studies have suggested that chronic helminth infections may protect against the development of T2DM, and have suggested an immunometabolic mechanism for such an effect.
Aims: This thesis seeks to examine the relationship between Strongyloides stercoralis infection and T2DM in an Australian Aboriginal community, and to examine the importance of this relationship in the context of efforts to treat and control this infection.
Methods: The thesis reports on a cross sectional observational study of adults attending the health centres in an Aboriginal community, testing them for both strongyloides infection and T2DM, and establishing the nature of the relationship between these two conditions. A cohort of infected and un-infected subjects is thereby established and followed over a three-year period, enabling characterization of both the treatment outcomes for this infection at 6 months and three years in the context of T2DM, and the effects that treatment for strongyloides has on subsequent metabolic parameters. In addition, the relationship between S. stercoralis infection, T2DM and eosinophilia is examined, and limited studies into the cytokine responses in treated individuals are performed
Results: The study demonstrates a strong negative association between pre-existing S. stercoralis infection and T2DM. It shows T2DM is a predictor of treatment failure for S. stercoralis at 6 months, and demonstrates that eosinophilia is not a reliable predictor of S stercoralis infection in this community, but is a more constant finding in those patients with S. stercoralis and T2DM. The three-year follow up shows that ivermectin is an extremely effective treatment for S. stercoralis infection in this community, and demonstrates that treatment of S. stercoralis infection is associated with an increased risk of developing T2DM and impaired glucose tolerance when compared to an uninfected and untreated group.
Conclusions: The thesis provides evidence to support a protective effect for S. stercoralis infection against T2DM and suggests an immunometabolic model to explain the negative association which has been found. These findings are discussed in the context of ongoing efforts to control and eliminate strongyloides infection in Australian Aboriginal communities.
| Item ID: | 55994 |
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| Item Type: | Thesis (PhD) |
| Keywords: | Aboriginal Australians, eosinophilia, Helminth infection, immunomodulation, Strongyloides stercoralis, type 2 diabetes mellitus |
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| Copyright Information: | Copyright © 2018 Russell John Hays |
| Additional Information: | Publications arising from this thesis are available from the Related URLs field. The publications are: Chapter 2: Hays, Russell, Esterman, Adrian, Giacomin, Paul, Loukas, Alex, and McDermott, Robyn (2015) Does Strongyloides stercoralis infection protect against type 2 diabetes in humans? Evidence from Australian Aboriginal adults. Diabetes Research and Clinical Practice, 107 (3). pp. 355-361. Chapter 3: Hays, Russell, Esterman, Adrian, and McDermott, Robyn (2015) Type 2 diabetes mellitus is associated with Strongyloides stercoralis treatment failure in Australian aboriginals. PLoS Neglected Tropical Disease, 9 (8). pp. 1-10. Chapter 4: Hays, Russell, Thompson, Fintan, Esterman, Adrian, and McDermott, Robyn (2016) Strongyloides stercoralis, eosinophilia, and Type 2 Diabetes Mellitus: the predictive value of eosinophilia in the diagnosis of S stercoralis infection in an endemic community. Open Forum Infectious Diseases, 3 (1). pp. 1-6. Chapter 5: Hays, Russell, Esterman, Adrian, and McDermott, Robyn (2017) Control of chronic Strongyloides stercoralis infection in an endemic community may be possible by pharmacological means alone: Results of a three-year cohort study. PLoS Neglected Tropical Diseases, 11 (7). Chapter 6: Hays, Russell, Giacomin, Paul, Olma, Lennart, Esterman, Adrian, and McDermott, Robyn (2017) The relationship between treatment for Strongyloides stercoralis infection and type 2 diabetes mellitus in an Australian Aboriginal population: a three-year cohort study. Diabetes Research and Clinical Practice, 134. pp. 8-16. |
| Date Deposited: | 31 Oct 2018 22:33 |
| FoR Codes: | 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 50% 11 MEDICAL AND HEALTH SCIENCES > 1108 Medical Microbiology > 110803 Medical Parasitology @ 50% |
| SEO Codes: | 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920104 Diabetes @ 50% 92 HEALTH > 9203 Indigenous Health > 920301 Aboriginal and Torres Strait Islander Health - Determinants of Health @ 50% |
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