# Anthelmintic and Antibiotic Therapy Resolves Intestinal Inflammatory Infiltration in Experimental Trichuriasis

## TL;DR

Combining albendazole and antibiotics reduced inflammation and bacterial spread in mice infected with a type of intestinal worm.

## Contribution

Demonstrates that combining anthelmintic and antibiotic therapies can more effectively control trichuriasis and its complications.

## Key findings

- Untreated mice had more peritoneal macrophages compared to treated groups.
- Combined treatment reduced nematode colonization and bacterial translocation.
- Antibiotic treatment alone prevented bacterial invasion in the epithelial submucosa.

## Abstract

Despite significant advances in human health, soil-transmitted
helminths (STH) continue to pose a major public health challenge,
particularly in impoverished regions. Albendazole has been used to
treat STH for over 40 years and remains widely utilized in mass drug
administration programs. However, it is estimated that over 1.5 billion
people are still infected globally, with Brazil reporting a prevalence
of 5.41% for human trichuriasis. The nematode Trichuris
muris is widely used in murine models to study trichuriasis
due to its impact on the epithelial mucosa, including tissue damage,
dysbiosis, bacterial translocation, inflammatory infiltrate, and intestinal
layer hypertrophy. These effects contribute to the more severe consequence
of high parasite load infections, such as rectal prolapse. Currently,
research on the interaction between intestinal helminths and bacteria
remains limited, despite its potential contribution to pathological
synergy. Drug resistance in conventional STH treatments is a growing
concern, highlighting the need for new therapeutic approaches. This
study aimed to evaluate the impact of combining the anthelmintic albendazole
with the antibiotics piperacillin sodium plus tazobactam on the inflammatory
process during chronic experimental trichuriasis. Swiss Webster mice
were infected with 150 embryonated T. muris eggs. After 35 days, the mice were divided into four groups: Group
1 (antibiotic treatment), Group 2 (anthelmintic treatment), Group
3 (combined treatment), and Group 4 (control, no treatment). After
treatments, the mice were euthanized, and different analyses were
conducted. Results showed that untreated mice had a significantly
higher number of peritoneal macrophages compared to those that received
treatment. Antibiotic-treated mice did not show invading bacteria
in the epithelial submucosa, unlike untreated infected mice. The groups
that received anthelmintic treatment exhibited a higher number of
dead worms compared to the antibiotic-only group. Additionally, the
combination of anthelmintic and antibiotic treatments demonstrated
more effective control of nematode colonization and bacterial translocation,
potentially reducing the secondary impacts of the infection, such
as bacterial translocation and the associated inflammatory processes.
These findings suggest that our results could pave the way for the
development of new treatment protocols for STH, integrating both anthelmintic
and antibiotic therapies.