## 4 Discussion
We observed that the WBC and platelet concentrations were higher at day 28 pi among the D group when compared with the Tz and TzD. Our finding agrees with previous studies which reported that platelet counts are higher and contribute to vascular events in insulin-resistant patients [48]. An increase in WBC and platelets coupled with high blood glucose in patients with diabetes mellitus may be a result of a stress response, inflammation and infectious diseases [49]. A significant decrease in lymphocyte counts observed in the D and TzD may signify high antigenic stimulation, which leads to the accelerated transformation of lymphocytes to plasma cells, leading to anti-Tz antibody production, resulting in lymphopaemia, following chronic Tz infection [50]. The observation in our present study is also consistent with findings from a previous study which showed lymphopenia following co-infection of _Trypanosoma brucei_ and _Plasmodium berghei_ (Pb) in mice [51]. Significantly increased levels of eosinophils were observed at day 35 pi in the TzD group when compared to the D and Tz groups, although we expected to observe the same results with the Tz group as eosinophil is normally associated with parasitic infections. This result in the TzD group is in partial agreement with a previous study that demonstrated increased peripheral blood and tissue eosinophil, which characterizes trichinellosis in humans [52]. An increase in neutrophils (\(p<0.001\)) was observed in the D group at day 35 pi, and also in the TzD (\(p<0.01\)) in comparison to the Tz group. Neutrophils play a vital role during host inflammatory response against infection [53], and it has been documented that the chemotactic activity of neutrophils from patients with diabetes is significantly reduced when compared to cells from healthy controls [54]. An elevated monocyte concentration was observed in the D group at day 28 pi when compared to the TzD and Tz. Monocytes are secreted by the bone marrow and their function in blood is not different from the role of macrophages in tissues [55; 50]. TNF-\(\alpha\) and IFN-\(\gamma\) concentration were elevated in the TzD when compared to the D group at day 14 and 28 pi. Our study is in contrast with the previous study by [PERSON] et al. [56] which showed low IFN-\(\gamma\) and TNF-\(\alpha\), concentrations in T2 DM patients infected with _Strongyloides stercoralis_ than those with T2 DM only. Increased proinflammatory cytokines production such as IFN-\(\gamma\) and TNF-\(\alpha\) is pivotal in pancreatic \(\beta\)-cells obliteration and insulin resistance in the muscle, liver and adipose tissue [10]. IL-6 concentration showed a significant reduction in the Tz group when compared to the D and the TzD groups, and this is consistent with the study of [PERSON] et al. [11], where similar results were found in patients comorbid with helminth infection and T2 DM. However, reported elevated levels of IL-1\(\beta\) and IL-6 are predictive of T2 DM [57; 58], which are indicative of innate immune cells activation in response to high nutrient concentration [11]. This response in T2 DM contributes to glucocorticoids, lipotoxicity, oxidative and endoplasmic reticulum stress (ER) of pancreatic islets [59]. IL-4 concentration showed a significant elevation in the TzD group when compared to D and Tz groups. Our finding agrees with a previous report from [PERSON] et al. [60] which demonstrated that diabetic mice with infected _Litomosoides sigmodontis_ showed an increase in the production of type 2 cytokines IL-4 when compared to the uninfected mice. Several molecules are involved type 2 immune responses, including the type 2 cytokines IL-4, IL-5, and IL-13, which are influenced by chronic helminth infections [61]. There was a significant increase in IL-10 concentration in the TzD group in comparison to the D and the Tz groups on day 28 pi. A previous study by [PERSON] et al. [31] reported the elevation of regulatory cytokine IL-10 concentrations during the establishment of the larvae in the striated muscle cells.