The role of interspecific interactions in the structure of gastrointestinal helminth communities has been at the core of most research in parasite community ecology, yet there is no consensus regarding their general importance. There have been two different approaches to the study of species interactions in helminths. The first one consists of measuring the responses of helminth species in concomitant infections, preferably in laboratory experiments. Any change in numbers of parasite individuals or in their use of niche space, compared with what is observed in single infections, provides solid evidence that the species are interacting. The second approach can only provide indirect, circumstantial evidence. It consists in contrasting observed patterns either in the distribution of species richness of infracommunities from wild hosts, in their species composition, or in pairwise associations between helminth species among infracommunities, with the random patterns predicted by appropriate null models. In many cases, observed patterns do not depart from predicted ones; when they do, alternative explanations are usually as plausible as invoking the effect of interactions among helminth species. The present evidence suggests that the role of species interactions in helminth community structure is often negligible, but that it must always be evaluated on a case-by-case basis.

The changes in prevalence and abundance of the three species of metacercariae in the humour of the eyes of perch Perca fluviatilis in Slapton Ley, Devon, have been monitored over a period of 29 years. Earlier studies had revealed that Diplostomum gasterostei was originally the sole occupant of this niche, but Tylodelphys clavata colonised in 1973 and T. podicipina in 1976. A decline in the number of perch with heavy infections of D. gasterostei was significantly negatively correlated with population abundance of T. clavata and a decline in recruitment rate of D. gasterostei coincided with the population increase in T. podicipina over the period 1976–1979. It was suggested that the decline in population size of D. gasterostei was due to inter-specific competition, but this hypothesis could not be tested experimentally. Subsequent investigations, reported here, confirmed the decline when the data set was extended to 1985. A severe decline in the perch population over the winter of 1984/1985 resulted in the disappearance of D. gasterostei and T. podicipina and this was followed by a slow recovery from 1990 onwards. This natural experiment provided an opportunity to test the hypothesis. Only T. clavata survived throughout the perch crash and the population continued at pre-crash levels up to 1999. Its congener T. podicipina did not re-appear until 1994 and was probably a re-introduction: it did not attain pre-crash levels until 1999. It is likely that D. gasterostei survived the crash as it re-appeared in 1991, but was confined to young of the year fish and barely approached pre-crash levels even in 1999. Its continual low levels cannot be explained by changes in the lake or in densities of snail intermediate or bird definitive hosts. New data revealed that the suspensory ligaments of the eye were the preferred site of all three species and that the eye was partitioned out between them. The data from the post-crash period do not refute but rather confirm earlier conclusions that inter-specific competition is responsible for the decline in D. gasterostei and this remains the preferred hypothesis.

Concomitant infections are common in nature and often involve parasites. A number of examples of the interactions between protozoa and viruses, protozoa and bacteria, protozoa and other protozoa, protozoa and helminths, helminths and viruses, helminths and bacteria, and helminths and other helminths are described. In mixed infections the burden of one or both the infectious agents may be increased, one or both may be suppressed or one may be increased and the other suppressed. It is now possible to explain many of these interactions in terms of the effects parasites have on the immune system, particularly parasite-induced immunodepression, and the effects of cytokines controlling polarization to the Th1 or Th2 arms of the immune response. In addition, parasites may be affected, directly or indirectly, by cytokines and other immune effector molecules and parasites may themselves produce factors that affect the cells of the immune system. Parasites are, therefore, affected when they themselves, or other organisms, interact with the immune response and, in particular, the cytokine network. The importance of such interactions is discussed in relation to clinical disease and the development and use of vaccines.

Multiple species infections with parasitic helminths, including nematodes, are common in wild rodent populations. In this paper we first define different types of associations and review experimental evidence for different categories of interactions. We conclude that whilst laboratory experiments have demonstrated unequivocally that both synergistic and antagonistic interactions involving nematodes exist, field work utilizing wild rodents has generally led to the conclusion that interactions between nematode species play no, or at most a minor, role in shaping helminth component communities. Nevertheless, we emphasize that analysis of interactions between parasites in laboratory systems has been fruitful, has made a fundamental contribution to our understanding of the mechanisms underlying host-protective intestinal immune responses, and has provided a rationale for studies on polyparasitism in human beings and domestic animals. Finally, we consider the practical implications for transmission of zoonotic diseases to human communities and to their domestic animals, and we identify the questions that merit research priority.

Heterologous immunity, or protection by one invading organism against another across phylogenetic divides, has been recognised for decades. It was initially thought to operate largely through enhancement of phagocytosis, but this explanation became untenable when it was realised it worked extremely well against intraerythrocytic protozoa and killed them while they were free in the circulation. Clearly a soluble mediator was called for. This review summarises the logic that arose from this observation, which led to a wider appreciation of the roles of pro-inflammatory cytokines, and then nitric oxide, in the host's response against invaders, as well as the ability of these mediators to harm the host itself if they are generated too enthusiastically. This has led to a discernable pattern across heterologous immunity as a whole, and its lessons influence a range of areas, including vaccine development.

Immunological data indicate that different subsets of T-helper cells work best against different types of infection. Concomitant infection of a host may thus impose either conflicting or synergistic immune response requirements, depending upon the extent to which the component optimal immune responses differ. Drawing upon empirically-determined optimal responses to single-species infections, an optimality model is here used to generate testable hypotheses for optimal responses to concomitant infection. The model is based upon the principle that the joint immune response will minimize divergence from each of the optima for single-species infections, but that it will also be weighted by the importance of mounting the correct response against each infectious organism. The model thus predicts a weighted average response as the optimal response to concomitant infection. Data on concomitant infection of murine hosts by the parasites Schistosoma mansoni and Toxoplasma gondii will provide the first test of the optimality model. If the weighted average hypothesis holds true, then there are no emergent immunological properties of concomitant infections and we may be able to understand immune responses to concomitant infection directly via our understanding of single-species infections.

In the last two decades, major immunodeficiency syndromes have strongly influenced medical parasitology. Some animal parasitoses, once unknown in human medicine, have become zoonotic and sometimes anthroponotic. In other cases, the clinical evolution of human parasitoses has been severely aggravated and/or modified in immunodeficient patients especially in toxoplasmosis, cryptosporidiosis, leishmaniasis, strongyloidiasis and scabies. The parasites implicated are varied (protozoa, helminths and even Acaridae) but have in common the capacity to reproduce in or on the human host. These immunodeficiency syndromes are often related to AIDS but other major immunodepressions, such as post-therapeutically in organ transplantation, may also be responsible and raise difficult problems for prevention. The immunological mechanisms involved are not always well understood. In addition, genetic predisposition factors, gradually becoming better-understood in parasites and man, complete and complicate our understanding of the immunological mechanisms.

Parasitic worm infections are amongst the most widespread of all chronic human infections. It is estimated that there are more than 3 billion infections in the world today. In many low income countries it is often more common to be infected than not to be. Indeed, a child growing up in an endemic community can expect be infected soon after weaning, and to be infected and constantly reinfected for the rest of her or his life. Infection is most common amongst the poorest and most disadvantaged communities, and is typically most intense in children of school going age. As the risk of morbidity is directly related to intensity of infection, it follows that children are the most at risk from the morbid effects of disease. Multiparasite infections are also common in such communities and there is evidence that individuals harbouring such infections may suffer exacerbated morbidity, making children even more vulnerable. Thus, these infections pose a serious threat to the health and development of children in low income countries. For many years, the need to control these infections has lain uncontested, and with the advent of broad-spectrum anthelminthic drugs that are cheap, safe and simple to deliver, control has at last become a viable option for many communities. Furthermore, there is now increased emphasis being placed on a multispecies approach as a cost-effective mechanism to control the morbidity of virtually all the major helminthic infections of humans.

Multiple parasitic infections have become increasingly recognized as a result of improvements in laboratory diagnosis and a growing population of immunocompromised individuals. This review examines the principles of chemotherapy in groupings of multiple infections which are of particular clinical significance.