AVIAN INFLUENZA

(Fowl Plague)
Definition
Avian influenza (AI) is a disease of viral etiology that ranges from a
mild or even asymptomatic infection to an acute, fatal disease of
chickens, turkeys, guinea fowls, and other avian species, especially
migratory waterfowl (1,,!,",#,$,1%,11)&
Etiology
Fowl plague was descri'ed in 1#(# as a serious disease of chickens in
Italy& It was determined in 1$)) that fowl plague (FP) virus is actually
one of the influenza viruses& *he AI viruses, along with the other
influenza viruses, make up the virus family +rthomy,oviridae& *he
virus particle has an envelope with glycoprotein pro-ections with
hemagglutinating and neuraminidase activity& *hese two surface
antigens, hemagglutinin (.A) and neuraminidase (/A), are the 'asis of
descri'ing the serologic identity of the influenza viruses using the
letters . and / with the appropriate num'ers in the virus designation
e&g&, .(/& *here are now 1) hemagglutinin and $ neuraminidase
antigens descri'ed among the *ype A influenza viruses& *he type
designation (A, 0, or 1) is 'ased upon the antigenic character of the 2
protein of the virus envelope and the nucleoprotein within the virus
particle& All influenza viruses affecting domestic animals (e3uine,
swine, avian) 'elong to *ype A, and *ype A influenza virus is the most
common type producing serious epidemics in humans& *ypes 0 and 1
do not affect domestic animals&
1lassical fowl plague viruses have .( as one of the surface antigens
'ut can have different / antigens& It was once 'elieved that all .(
viruses are highly pathogenic fowl plague viruses and that no other
avian influenza viruses could produce a fowl4plague4like disease& 5hen
avirulent AI viruses with the .( antigens were demonstrated in
turkeys in 1$(1 and highly virulent AI viruses with the .) antigen
were first found in chickens in 1$)$, the necessity for redefining the
term fowl plague or using other terminology 'ecame apparent&
0ecause there are highly virulent AI viruses that possess . antigen
other than the .( and .( AI viruses that do not produce clinical fowl
plague, an international assem'ly of avian influenza specialists
proposed that the term fowl plague no longer 'e used& *hey suggested
that any AI virus, regardless of its .A designation, meeting specified
virulence re3uirements in the la'oratory 'e designated highly
pathogenic avian influenza (.PAI)& *he criteria that serve as the 'asis
for classifying an AI virus as .PAI has more recently 'een modified to
include molecular considerations such as the type of amino acids at
the cleavage site of its .A& *his chapter will 'e limited to descri'ing
the .PAI and not the AI viruses of less virulence and pathogenicity&
Host Range
2ost avian species appear to 'e suscepti'le to at least some of the AI
viruses& A particular isolate may produce severe disease in turkeys 'ut
not in chickens or any other avian species& *herefore, it would 'e
impossi'le to generalize on the host range for .PAI, for it will likely
vary with the isolate& *his assumption is supported 'y reports of farm
out'reaks where only a single avian species of several species present
on the farm 'ecame infected& 6wine appear to 'e important in the
epidemiology of infection of turkeys with swine influenza virus when
they are in close pro,imity& +ther mammals do not appear to 'e
involved in the epidemiology of .PAI& *he infection of humans with an
.) avian influenza virus in .ong .ong in 1$$( has resulted in a
reconsideration of the role of the avian species in the epidemiology of
human influenza&
Geographic Distribution
.ighy pathogenic avian influenza viruses have periodically occurred in
recent years in Australia (.(), 7ngland (.(), 6outh Africa (.)),
6cotland (.)), Ireland (.)), 2e,ico (.)), Pakistan (.(), and the
8nited 6tates (.))& 0ecause la'oratory facilities are not readily
availa'le in some parts of the world to differentiate /ewcastle disease
and .PAI, the actual incidence of .PAI in the world9s poultry flocks is
difficult to define& It can occur in any country, regardless of disease
control measures, pro'a'ly 'ecause of its prevalence in wild migratory
waterfowl, sea 'irds and shore 'irds&
Avian influenza has produced losses of varia'le severity, primarily in
turkeys in the 8nited 6tates, since the mid41$:%9s& *he disease
out'reaks in turkeys in the 8nited 6tates have 'een caused 'y AI
viruses with many of the .A designations& It was in the fall of 1$#!
that a highly virulent .) virus produced severe clinical disease and
high mortality in chickens, turkeys, and guinea fowl in Pennsylvania&
*his severe disease, clinically indistinguisha'le from classical fowl
plague, occurred after a serologically identical 'ut apparently mild
virus had 'een circulating in poultry in the area for : months&
+ut'reaks of less virulent AI have fre3uently 'een descri'ed in
domestic ducks in many areas of the world& *he AI viruses are often
recovered from apparently healthy migratory waterfowl, shore 'irds,
and sea 'irds worldwide& *he epidemiologic significance of these
isolations relative to out'reaks in domestic poultry has led to the
generally accepted 'elief that waterfowl serve as the reservoir of
influenza viruses&
Transmissions
*here is a considera'le 'ody of circumstantial evidence to support the
hypothesis that migratory waterfowl, sea 'irds, or shore 'irds are
generally responsi'le for introducing the virus into poultry& +nce
introduced into a flock, the virus is spread from flock to flock 'y the
usual methods involving the movement of infected 'irds, contaminated
e3uipment, egg flats, feed trucks, and service crews, to mention a
few& Preliminary trapping evidence indicates that gar'age flies in the
Pennsylvania out'reak were sources of virus on the premises of the
diseased flocks& ;irus may readily 'e isolated in large 3uantities from
the feces and respiratory secretions of infected 'irds& It is logical to
assume, therefore, that 'ecause virus is present in 'ody secretions,
transmission of the disease can take place through shared and
contaminated drinking water& Air'orne transmission may occur if 'irds
are in close pro,imity and with appropriate air movement& 0irds are
readily infected via instillation of virus into the con-unctival sac, nares,
or the trachea& Preliminary field and la'oratory evidence indicates that
virus can 'e recovered from the yolk and al'umen of eggs laid 'y hens
at the height of the disease& *he possi'ility of vertical transmission is
unresolved< however, it is unlikely infected em'ryos could survive and
hatch& Attempts to hatch eggs in disease isolation ca'inets from a
'roiler 'reeder flock at the height of disease failed to result in any AI4
infected chickens& *his does not mean that 'roken contaminated eggs
could not 'e the source of virus to infect chicks after they hatch in the
same incu'ator& *he hatching of eggs from a diseased flock would
likely 'e associated with considera'le risk&
Incubation Period
*he incu'ation period is usually ! to ( days, depending upon the
isolate, the dose of inoculum, the species, and age of the 'ird&
Clinical Signs
Infections of .PAI result in marked depression with ruffled feathers,
inappetence, e,cessive thirst, cessation of egg production, and watery
diarrhea& 2ature chickens fre3uently have swollen com's, wattles (Fig&
)), and edema surrounding the eyes& *he com's are often cyanotic at
the tips and may have plasma or 'lood vesicles on the surface with
dark areas of ecchymotic hemorrhage and necrotic foci (Fig& :)& *he
last eggs laid, after the onset of illness, are fre3uently without shells&
*he diarrhea 'egins as watery 'right green and progresses to almost
totally white& 7dema of the head, if present, is often accompanied 'y
edema of the neck& *he con-unctivae are congested and swollen with
occasional hemorrhage& *he legs, 'etween the hocks and feet, may
have areas of diffuse hemorrhage (Fig& ()& =espiratory signs can 'e a
significant feature of the disease, depending on the e,tent of tracheal
involvement& 2ucus accumulation can vary& It is not unusual in caged
layers for the disease to 'egin in a localized area of the house and
severely affect 'irds in only a few cages 'efore it spreads to
neigh'oring cages&
>eath may occur within " hours of first signs of disease, fre3uently
within "# hours, or 'e delayed for as long as a week& 6ome severely
affected hens may occasionally recover&
In 'roilers, the signs of disease are fre3uently less o'vious with severe
depression, inappetence, and a marked increase in mortality 'eing the
first a'normalities o'served& 7dema of the face and neck and
neurologic signs such as torticollis and ata,ia may also 'e seen&
*he disease in turkeys is similar to that seen in layers, 'ut it lasts or
! days longer and is occasionally accompanied 'y swollen sinuses&
In domestic ducks and geese the signs of depression, inappetence, and
diarrhea are similar to those in layers, though fre3uently with swollen
sinuses& ?ounger 'irds may e,hi'it neurologic signs&
Gross Lesions
0irds that die with the peracute disease and young 'irds may not have
significant gross lesions other than severe congestion of the
musculature and dehydration& In the less acute form, and in mature
'irds, significant gross lesions are fre3uently o'served& *hey may
consist of su'cutaneous edema of the head and neck area, which is
evident as the skin is reflected (Fig& #)& Fluid may e,it the nares and
oral cavity as the 'ird is positioned for postmortem e,amination& *he
con-unctivae are severely congested@ occasionally with petechiation&
*he trachea may appear relatively normal e,cept that the lumen
contains e,cessive mucous e,udate& It may also 'e severely involved
with hemorrhagic tracheitis similar to that seen with infectious
laryngotracheitis& 5hen the 'ird is opened, pinpoint petechial
hemorrhages are fre3uently o'served on the inside of the keel as it is
'ent 'ack& ;ery small petechia may cover the a'dominal fat, serosal
surfaces, and peritoneum, which appears as if it were finely splattered
with red paint& Aidneys are severely congested and may occasionally
'e grossly plugged with white urate deposits in the tu'ules&
In layers, the ovary may 'e hemorrhagic or degenerated with
darkened areas of necrosis& *he peritoneal cavity is fre3uently filled
with yolk from ruptured ova, causing severe airsacculitis and
peritonitis in 'irds that survive for ( to 1% days&
.emorrhages may 'e present on the mucosal surface of the
proventriculus @ particularly at the -uncture with the gizzard& *he
lining of the gizzard peels easily and fre3uently reveals hemorrhages
and erosions underneath& *he intestinal muscosa may have
hemorrhagic areas @ especially in the lymphoid foci such as the cecal
tonsils& *he gross lesions are not distinctly different from those
o'served with velogenic viscerotropic /ewcastle disease (;;/>)& *he
lesions in turkeys and domestic ducks are similar to those in chickens
'ut may not 'e as marked&
orbidity and ortality
*he prognosis for flocks infected with .PAI is poor& 2or'idity and
mortality rates may 'e near 1%% percent within to 1 days after the
first signs of illness& 0irds that survive are usually in poor condition
and resume laying only after a period of several weeks&
Diagnosis
Field Diagnosis
.ighly pathogenic avian influenza is suspected with any flock where
sudden deaths follow severe depression, inappetence, and a drastic
decline in egg production& *he presence of facial edema, swollen and
cyanotic com's and wattles, and petechial hemorrhages on internal
mem'rane surfaces increases the likelihood that the disease is .PAI&
.owever, an a'solute diagnosis is dependent upon the isolation and
identification of the causative virus& 1ommercially availa'le type A
influenza antigen4capture enzyme linked immunosor'ent assay kits
designed for use in human influenza have recently shown promise as a
possi'le rapid diagnositic test for poultry&
Specimens for Laboratory
6pecimens sent to the la'oratory should 'e accompanied 'y a history
of clinical and gross lesions, including any information on recent
additions to the flock& >iagnosis depends upon the isolation and
identification of the virus from tracheal or cloacal swa's, feces, or from
internal organs ())& 6pecimens should 'e collected from several 'irds&
It is not unusual for many of the su'mitted specimens to fail to yield
virus& 6wa's are the most convenient way to transfer AI virus from
tissues or secretions of the suspect 'ird to 'rain and heart infusion
'roth or other cell culture maintenance medium containing high levels
of anti'iotics& >ry swa's should 'e inserted deeply to ensure o'taining
ample epithelial tissue& *rachea, lung, spleen, cloaca, and 'rain should
'e sampled& If large num'ers of dead or live 'irds are to 'e sampled,
cloacal swa's from up to five 'irds can 'e pooled in the same tu'e of
'roth& An alternative techni3ue is to place %&) cm
!
of each tissue into
the 'roth& 0lood for serum should 'e collected from several 'irds& If
the specimens can 'e delivered to a la'oratory within " hours, they
should 'e placed on ice& If delivery will take longer, 3uickfreeze the
specimens and do not allow them to thaw during transit&
Laboratory Diagnosis
/ine to 114day4old em'ryonated chicken eggs are inoculated with
swa' or tissue specimens& Avian influenza virus will usually kill
em'ryos within "#4( hours& If the virus isolated is identified as a
*ype A influenza virus, through the ABP or 7CI6A tests, it is then
tested using a 'attery of specific antigens to identify its serologic
identity (.A and /A type)&
6era from infected chickens usually yield positive anti'ody tests as
early as ! or " days after first signs of disease&
Differential Diagnosis
.ighly pathogenic avian influenza is easily confused with ;;/>,
'ecause the disease signs and postmortem lesions are similar, and
may also 'e confused with infectious laryngotracheitis and acute
'acterial diseases such as fowl cholera and Escherichia coli. .owever,
in an area where AI is prevalent, such as during an out'reak, sound
presumptive diagnoses can 'e made 'y flock history, signs, and gross
lesions&
Treatment
Amantadine hydrochloride has 'een licensed for use in humans to
treat influenza since 1$::& *he medication is effective in reducing the
severity of influenza *ype A in humans& 7,perimental evidence
indicated possi'le efficaciousness in poultry when the drug was
administered in drinking water to reduce disease losses, 'ut drug4
resistant viruses 3uickly emerged, negating the initial 'eneficial
effects& *hus, the drug is not recommended for use in poultry&
!accination
Inactivated oil4emulsion vaccines, although fairly e,pensive, have
'een demonstrated to 'e effective in reducing mortality, preventing
disease, or 'oth, in chickens and turkeys (()& *hese vaccines may not,
however, prevent infection in some individual 'irds, which go on to
shed virulent virus& 2ore economical via'le vaccines prepared using
naturally avirulent or attenuated strains have the disadvantage of the
possi'le creation of reassortant influenza viruses with unpredicta'le
characteristics& *hese reassortants could result when a single host 'ird
is simultaneously infected with 'oth the vaccine and another AI virus&
+wing to the segmented nature of the influenza virus genome, a
reassortment of genetic material can readily occur, creating new
influenza viruses& *he 'asic draw'ack to any vaccine approach for the
control of .PAI is the large num'er of .A su'types that can cause the
disease& 0ecause there is no cross4protection among the 1) known .A
su'types, either a multivalent vaccine will 'e needed or vaccination
postponed until the prevalent disease4causing su'type in the area is
identified& A recom'inant fowl po, virus vaccine containing the gene
that codes for the production of the .) antigen has recently 'een
licensed& *he use of a recom'inant insect virus containing the gene for
either the .) or .( antigen has 'een used to make these vaccine
proteins in insect cell cultures&
Control and Eradication
*he practice of accepted sanitation and 'iosecurity procedures in the
rearing of poultry is of utmost importance& In areas where waterfowl,
shore 'irds, or sea 'irds are prevalent, the rearing of poultry on open
range is incompati'le with a sound AI prevention program (1)&
Appropriate 'iosecurity practices should 'e applied, including the
control of human traffic and introduction of 'irds of unknown disease
status into the flock& 1leaning and disinfection procedures are the
same as those recommended in the chapter on velogenic /ewcastle
disease&
Public Health
*he AI viruses are *ype A influenza viruses, and the possi'ility e,ists
that they could 'e involved in the development, through genetic
reassortment, of new mammalian strains& An influenza virus isolated
from har'or seals that died of pneumonia had the .A and /A surface
antigens of an influenza virus isolated from turkeys a decade earlier&
*he infection and deaths of : of 1# humans infected with an .) avian
influenza virus in .ong .ong in 1$$( has resulted in a reconsideration
of the portentous role that the avian species have on the epidemiology
of human influezna& Previously there was only one report of a human
'ecoming infected with an .( AI virus& Is is impossi'le to predict the
importance of AI virus in determining the strains of virus that infect
humans& *here was no evidence to indicate that humans coming in
contact with large 3uantities of the .)/ virus during depopulation
efforts in the .PAI out'reak of 1$#! in Pennsylvania 'ecame infected
with the virus&
GUIDE T T!E LITE"ATU"E
1& AC7DA/>7=, >&E& 1$#& Avian Influenza 4=ecent developments& ;et&
0ull&, )F !"14!)$&
& Proceedings of the First International 6ymposium on Avian
Influenza, April 4", 1$#1, 0eltsville, 2>, =& A& 0ankowski, 7d&,
1arter Printing 1o& Ci'& 1ong& 1at& 1ard /o& #14(1:$&
!& Proceedings 6econd International 6ymposium on Avian Influenza&
6epem'er !4), 1$#:& Athens, BA, =ichmond, ;AF 8&6& Animal .ealth
Assoc&, Ci'& 1ong& 1at& 1ard /o& #:4%)1"!&
"& Proceedings of the *hird International 6ymposium on Avian
Influenza& 2ay (4$, 1$$& 2adison, 5I, =ichmond, ;AF 8&6& Animal
.ealth Assoc&, Ci'& 1ong& 1at& 1ard /o& $4%:1$#&
)& 07A=>, 1&5& 1$#$& Influenza& In A Ca'oratory 2anual for the
Isolation and Identification of Avian Pathogens, !d ed& .& B& Purchase
et al&, eds&, Aennett 63uare, PAF American Association Avian
Pathologists, pp& 11%411!& Ci'& 1ong& 1at& 1ard /o& #$4#%:%
:& 07A=>, 1&5& 1$#$& 6erologic Procedures& In A Ca'oratory 2anual
for the Isolation and Identification of Avian Pathogens& !d ed& .& B&
Purchase et al&, eds&, Aennett 63uare, PAF American Association Avian
Pathologists, pp& 1$4%%& Ci'& 1ong& 1at& 1ard /o& #$4#%:%&
(& 0=8B., 2&, 07A=>, 1&5&, and 6*+/7, .&>& 1$($& Immunization of
chickens and turkeys against avian influenza with monovalent and
polyvalent oil emulsion vaccines& Amer& E& ;et& =esearch, "%F1:)41:$
#& 7A6*7=>A?, 0&1&, and 07A=>&5& 1$#"& Avian Influenza& >iseases
of Poultry, #th ed& 2& 6& .ofstad et al&, eds&, Ames, IAF Iowa 6tate
8niversity Press, & pp& "#4"$: &
$& 7A6*7=>A? 0&1&, and .I/6.A5,;&6& 1$$1& Influenza& In >iseases
of Poultry, $th ed& 0& 5& 1alnek et al,& eds&, Ames, IAF Iowa 6tate
8niversity Press, pp& )!4))1&
1%& 7A6*7=>A?, 0&1&, .I/6.A5, ;&6&, and .AC;+=6+/, >&A& 1$$(&
Influenza& In >iseases of Poultry, 1%th ed&, 0&5& 1alnek, et al, eds&,
Ames, IAF Iowa 6tate 8niversity Press, pp& )#!4:%)&
11& 7A6*7=>A?, 0&1&, and *82+;A, 0& 1$(#& Avian Influenza& In
>iseases of Poultry, (th ed&, 2&6& .ofstad et al&, eds&, Ames, IAF Iowa
6tate 8niversity Press&
1& .AC;+=6+/, >&A&, AA=8/AAA=A/, >&, 67//7, >&, A7CC7.7=, 1&,
0AIC7?, 1&, A0=A.A2, A&, .I/6.A5, ;&, and /752A/, E& 1$#!&
7pizootiology of Avian Influenza 4 4 6imultaneous monitoring of
sentinel ducks and turkeys in 2innesota& Avian >is&, (F((4#)&
1&5& 0eard, >&;&2&, 86>A, A=6& 6outheast Poultry =esearch
Ca'oratory, Athens
#$at Is A !oo%&orm Infection' (Ancylostomiasis)
*y Franc$ot Slot
Nic% S$a$+ ,D
-ersonal,d.com ,edical /ontrib0tors
#$at Is A !oo%&orm Infection'
.ookworm is an infection of one of two different ( to 1! mm long roundworms
(either Ancylostoma duodenale or Necator americanus)& If not treated, .ookworm
infection can lead to a'dominal pain and iron4deficiency& Appro,imately one43uarter
of the world9s population is infected with .ookworm&
!o& Do I Get A !oo%&orm Infection'
.ookworm eggs are passed in stool and infection results when a person comes in
contact with the eggs from the contaminated soil or stool& *he larvae enter through
the skin and travel to the lungs through the 'lood& *hey clim' up the lungs through
the 'ronchi and trachea and then are swallowed& As the
larvae pass into the digestive tract, they attach themselves to
the wall of the small intestine& .ere they mature into adult
worms, mate and feed on the 'lood of the host& Adult
hookworms may live up to ten years&
#$at Are T$e Symptoms f !oo%&orm'
2ost of the time a .ookworm infection does not show any
symptoms& .owever, the lifecycle of .ookworm takes it from
the skin to the 'lood, to the lungs and then, eventually, to the
intestines< thus, there may 'e symptoms from the infection in
any of these places& *here may 'e a local irritation of the skin
where the worm penetrated or even an itchy rash& In the
lungs, there may 'e asthma4like symptoms or pneumonia&
*he most common symptoms of .ookworm infection,
however, are from their residence in the intestine& .ere,
.ookworm can lead to a'dominal pain, diarrhea, weight loss, loss of appetite and
e,cessive gases& In chronic infections, the patient may 'ecome anemic as the worms
feed on the individual9s 'lood& *he loss of 'lood leads to a loss of iron and protein<
causing difficulty in 'reathing, pale comple,ion, tiredness and weakness, fast
heart'eat, generalized swelling or 'loating and impotence& If the infection lasts a
very long time or is very severe, there may 'e a slow growth, heart pro'lems or
even heart failure&
!o& Is !oo%&orm Diagnosed'
Cooking for the eggs in a stool sample directly, with a microscope, can identify
hookworm infection& A 'lood sample will also indicate if there is an iron or protein
deficiency from the infection& It will also indicate how serious the infection has
,icroscopic 1ie& of a
!oo%&orm egg.
affected on the patient&
!o& Is !oo%&orm Treated'
.ookworm is generally treated with the drug mebendazole& *his drug cures more
than $$ percent of all cases of hookworm if given twice per day for three days& It
kills 'oth the worms and the eggs& *his drug is contraindicated during pregnancy&
+ther drugs that may 'e given are al'endazole and pyrantel, which are given once
per day for three days& 6ince iron deficient anemia is a ma-or pro'lem with a
.ookworm infection, taking iron supplements and eating a high protein diet can
improve the person9s recovery&
!o& Long Do T$e Effects f !oo%&orm Last'
*he effects of .ookworm will depend upon the duration and severity of the infection&
*he a'dominal pain, diarrhea and gas usually resolve 3uickly with the elimination of
the worms& +nce the infection is cleared, 'ody may need several weeks to a few
months to 'uild 'ack up the protein, iron and vitamin levels that were lost due to the
infection& As these are replenished, the weakness, tiredness, difficulty 'reathing,
'loating or heart symptoms should gradually improve as well&
#$at /an *e Done To -re1ent !oo%&orm'
.ookworm infection results 'ecause of non4hygienic practices and fecal contact in
the soil< hence sanitation and sanitary practices are critical& Fecal matter should 'e
chemically treated and disposed off without any human contact& 5earing shoes can
prevent penetration of the worms into the skin of the feet& 5ater can also 'e a
mechanism of e,posure if it9s contaminated& *herefore, limiting swimming and
washing and any other contact with the water should 'e avoided until it9s treated or
'oiled to kill the larvae&
!o& /an I Ta%e /are f ,yself'
.ookworm infections should 'e dealt 3uickly and stringently& Anown symptomatic
infections should 'e treated rapidly along with asymptomatic family mem'ers or
neigh'ors& 6trict attention to cleanliness and sanitary practices is needed when a
.ookworm infection detected so as to prevent it9s spread& *his means proper
disposal of human waste, limiting skin contact with soil and water (not walking
'arefoot or swimming in areas where there is untreated sewage) and 'eing
diagnosed 'y a physician when symptoms are noted&
#$en S$o0ld I /all T$e Doctor'
.ookworm can 'e a very serious illness hence it9s essential to 'e vigilant of any
change in one9s health status& Any difficulty 'reathing, rapid heart'eat, chest or
a'dominal pain, 'loody diarrhea, 'lood with coughing, asthma type symptoms, skin
rash, swelling or 'loating, dizziness, confusion, lightheadedness or weight loss should
'e 'rought immediate to your doctor9s attention&
Nat0re2s "emedy For Intestinal Disease
0y Ceigh .opper, .ouston 1hronicle
American children (% years ago had a closer relationship with dirt than they do now&
*here were fewer sidewalks, paved roads and indoor toilets, and kids spent more
time playing outside in their 'are feet& As a result of this daily contact with soil,
almost all youngsters were infected with intestinal parasites such as hookworms,
pinworms or whipworms&
And that was a good thing&
At least that9s the thinking of Eoel 5einstock, a 8niversity of Iowa researcher who
'elieves regular doses of worms may 'e the key to treating people with
inflammatory 'owel disease, a serious and 'affling disorder that affects at least 1
million people nationwide&
GGAs we move into our sterile 'o,es, ('reathe) sterile air, we9re no longer 'eing
e,posed to some of the natural agents that may 'e re3uired for optimal development
of our immune systems,99 said 5einstock, director of the >igestive >isease 1enter at
the 8niversity of Iowa .ospitals and 1linics& GGAs we9ve de4wormed, people have
developed immune systems which are not dampened&99
*he cause of inflammatory 'owel disease, a term that encompasses 'oth ulcerative
colitis and 1rohn9s disease, is a mystery, 'ut it is presumed to result from poor
regulation of the intestinal immune system 44 an overreaction to normal intestinal
'acteria&
*he diseases usually 'egin in people during their late teens and %s and last a
lifetime& *hey cause a'dominal pain, diarrhea and gastrointestinal 'leeding& 6ections
of the intestine may 'ecome 'locked 'y scar tissue and re3uire surgical removal&
*hose afflicted are at greater risk for colon cancer&
1urrently, there isn9t a cure, 'ut anti'iotics, steroids, pain and immune4modulating
drugs such as cyclosporine help reduce symptoms&
In the 8nited 6tates and other industrialized countries, the disorder is rampant&
.owever, 5einstock notes, the condition is rare in poor countries where parasitic
worm infection is common&
=esearchers have learned that the intestine houses a comple, ecosystem, including
%% to !%% different species of 'acteria as well as various viruses and parasites& All
of the inha'itants modulate the intestinal immune system, which is largely governed
'y two types of *4cells, called *.1 and *., found in the intestinal lining&
*.1 induces inflammation, *. neutralizes the inflammatory response& For unknown
reasons, many parasitic infections induce a pure *., anti4inflammatory, response&
5einstock theorizes that man and the lowly worm co4evolved to 'ecome
interdependent& .e 'elieves intestinal worms, or helminths, dampen the immune
response so they can thrive in humans& In the a'sence of these parasites, the human
intestinal inflammatory response is unchecked and goes into overdrive, causing
disease&
6tudies in mice conducted 'y 8niversity of Iowa researchers supported this worm4
as4good4guy idea& 2ice e,posed to helminthic worms were protected from the
development of inflammatory 'owel disease&
*his spring, working with colleagues >avid 7lliot and =o'ert 6ummers, 5einstock
gave si, patient volunteers a drink laced with the microscopic eggs of a worm that
doesn9t normally infect people& 6tandard treatments hadn9t helped these patients,
four of whom had 1rohn9s disease and two of whom suffered from ulcerative colitis&
Although these worms can survive in the human intestine, reaching nearly a half4
inch in length, they can9t reproduce and are e,pelled after a couple of months&
After ingesting the eggs, all si, patients improved su'stantially& Five went into
complete remission& *he treatment had no noticea'le side effects and the patients9
improvements lasted one to five months following the single dose&
GG*hese people were doing way, way 'etter than he (5einstock) hoped in his wildest
dreams& .e9s not saying this is the 'e4all, end4all& *his is something to 'e studied,99
said >r& Peter 7rnst, an immunologist at 8niversity of *e,as 2edical 0ranch in
Balveston who is familiar with 5einstock9s research& GGIt9s a logical thing to do and
so far it seems to work &&& And we all hope it does&99
5einstock declined to specify which type of worm he used out of concern that
patients might 'e tempted to try it on their own and inadvertently contract a
dangerous parasite&
>r& Alan 0uchman, a professor of gastroenterology at the 8niversity of *e,as4
.ouston .ealth 6cience 1enter, called 5einstock9s idea GGan interesting hypothesis99
'ut said a study of si, patients is too small to 'e definitive& *reatments for 1rohn9s
and colitis typically have a !% to !) percent place'o response rate, he said& *he
place'o effect is a phenomenon in which people e,perience an improvement in their
condition in response to a phony therapy, such as a sugar pill&
5einstock9s team is now organizing a clinical trial with additional patients to compare
the treatment with a place'o and see if additional doses help& *he dou'le4'lind
study, in which neither researchers nor patients know who is getting worm eggs and
who is getting a place'o until the study9s completion, will 'egin in Eanuary&
GGA year from now, you might look 'ack and it means nothing,99 5einstock said&
GG*he 'ottom line is, it has potential& 5e will have to see 'efore we can say for sure
it9s helping people& 0ut we9re encouraged&99