Hookworm infection in children is associated with negative health outcomes in rural Alabama
Megan McKenna, MD
BACKGROUND: Preliminary studies have shown impoverished, high-risk environments in the U.S. (Lowndes County, Alabama) have evidence of hookworm infection with a low parasite burden, but no studies have been undertaken to evaluate the extent of current hookworm infection in children in the United States or the negative health impacts among this population, especially among those with low parasite burden. In addition, very few studies have been undertaken evaluating hookworm’s association with microbial translocation, and none have evaluated this impact with low parasite burden, making sensitive biomarkers for gastrointestinal injury and microbial translocation an ideal target of research to begin the comprehension of negative health impacts on this population.
GAP: Low burdens of hookworm infection are now being seen within the United States in high-risk, resource-poor areas, based on preliminary studies, but the impact of these low burdens of infections on children’s health, including anemia, iron deficiency, gastrointestinal injury, and microbial translocation, and the effect on health outcomes and parasite burden with treatment in these American areas are still unknown.
HYPOTHESIS: We hypothesize that children with hookworm infection will have lower hemoglobin and iron levels and higher values of intestinal fatty acid-binding protein (marker of gastrointestinal injury [I-FABP]) and soluble CD14 (marker of microbial translocation from the gastrointestinal tract [sCD14]) compared to negative controls, even in the setting of low parasite burden. We also hypothesize that soil parasite burden will be higher in areas with a higher prevalence of hookworm infection.
METHODS: This study is a cross-sectional, observational study, in which children (2-12 years old) will be selected to determine hookworm prevalence and burden, risk factors for infection, soil parasite burden near homes, and the correlation between infection burden and anemia, iron deficiency, gastrointestinal injury, and microbial translocation among a high-risk population with autochthonous infection in Lowndes County, Alabama.
IMPACT: This study will immediately impact the children with hookworm infection, as the families of children testing positive for hookworm infection will be informed of results and referred to a local physician for further testing and treatment. This work is important in demonstrating that neglected tropical diseases, especially soil-transmitted helminth infections, are not only a problem in endemic countries, but in resource-poor areas in the United States as well, and despite low burdens of disease, negative health outcomes are affecting children within these resource-poor communities, prompting future study and intervention.