In the Journals

Deworming programs do not have harmful effects on gut microbiome

Photo of Alice Easton
Alice Easton

A recent study published in mBio suggested that treatment with albendazole for hookworms and roundworms did not have a harmful effect on patients’ gut microbiome composition.

Alice Easton, PhD, a postdoctoral fellow at New York University Langone Health, told Infectious Diseases in Children that donated albendazole and mebendazole tablets are often given to at-risk children around the world who are part of deworming programs. WHO recommends deworming in areas where the baseline prevalence of any soil-transmitted infection is 20% or higher among children.

“Everyone in the global health community agrees that if a person has a worm infection and might be at risk for one of the types of morbidity associated with that infection — such as iron deficiency anemia from hookworms or intestinal blockages from roundworms — treatment will provide a considerable benefit to that person,” Easton added. “Our study shows that the side effects of clearing roundworm and hookworm infections on the microbiome do not appear to be a cause for concern.”

Easton and colleagues analyzed stool samples from residents of five villages in Kenya. The samples were collected before albendazole therapy, as well as 3 weeks and 3 months after therapy. The researchers used quantitative PCR to identify eight different intestinal parasite species.

Easton and colleagues said the presence of Ascaris lumbricoides or Necator americanus did not significantly alter the diversity of microbiota in stool samples before therapy.

Although presence of roundworms and hookworms may have had little effect on gut microbial composition, the treatment of parasitic worms — particularly hookworms — significantly altered the gut microbiome, according to the researchers. After albendazole therapy was completed and helminths were cleared, Easton and colleagues identified an increase in the proportion of microbiota made up of Clostridiales (P = .0002; average fold change = 0.57) and a decrease in the quantity of Enterobacteriales (P = .0004; average fold change = –0.58). In addition, the researchers observed a decrease in Chao1 richness following treatment, even when individuals were not infected with soil-transmitted helminths before treatment.

“We know that albendazole is safe, and WHO recommends treatment for anyone who is likely to be infected with a soil-transmitted helminth as long as the person is not aged younger than 1 year or in the first trimester of pregnancy,” Easton said. “The drug is safe enough that it is often easier and most cost-effective to give it to everyone in a community where infection rates are high than to test people before treating them. Our research adds one more piece to this puzzle by showing that we find no evidence of harmful changes to the gut microbiome resulting from successful removal of roundworms or hookworms.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Photo of Alice Easton
Alice Easton

A recent study published in mBio suggested that treatment with albendazole for hookworms and roundworms did not have a harmful effect on patients’ gut microbiome composition.

Alice Easton, PhD, a postdoctoral fellow at New York University Langone Health, told Infectious Diseases in Children that donated albendazole and mebendazole tablets are often given to at-risk children around the world who are part of deworming programs. WHO recommends deworming in areas where the baseline prevalence of any soil-transmitted infection is 20% or higher among children.

“Everyone in the global health community agrees that if a person has a worm infection and might be at risk for one of the types of morbidity associated with that infection — such as iron deficiency anemia from hookworms or intestinal blockages from roundworms — treatment will provide a considerable benefit to that person,” Easton added. “Our study shows that the side effects of clearing roundworm and hookworm infections on the microbiome do not appear to be a cause for concern.”

Easton and colleagues analyzed stool samples from residents of five villages in Kenya. The samples were collected before albendazole therapy, as well as 3 weeks and 3 months after therapy. The researchers used quantitative PCR to identify eight different intestinal parasite species.

Easton and colleagues said the presence of Ascaris lumbricoides or Necator americanus did not significantly alter the diversity of microbiota in stool samples before therapy.

Although presence of roundworms and hookworms may have had little effect on gut microbial composition, the treatment of parasitic worms — particularly hookworms — significantly altered the gut microbiome, according to the researchers. After albendazole therapy was completed and helminths were cleared, Easton and colleagues identified an increase in the proportion of microbiota made up of Clostridiales (P = .0002; average fold change = 0.57) and a decrease in the quantity of Enterobacteriales (P = .0004; average fold change = –0.58). In addition, the researchers observed a decrease in Chao1 richness following treatment, even when individuals were not infected with soil-transmitted helminths before treatment.

“We know that albendazole is safe, and WHO recommends treatment for anyone who is likely to be infected with a soil-transmitted helminth as long as the person is not aged younger than 1 year or in the first trimester of pregnancy,” Easton said. “The drug is safe enough that it is often easier and most cost-effective to give it to everyone in a community where infection rates are high than to test people before treating them. Our research adds one more piece to this puzzle by showing that we find no evidence of harmful changes to the gut microbiome resulting from successful removal of roundworms or hookworms.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.