Abstract
Anemia is a major public health problem in young children. Reports on the role of anemia on infectious diseases remained controversial. We aim to investigate the effect of anemia on innate immunity, nasopharyngeal bacterial colonization, and subsequent infectious outcome. Blood tests were examined at the age of 12 months. TLR-induced cytokine production was assessed by ELISA. Bacteria from nasopharyngeal specimens were identified with traditional culture. Clinical infectious diseases were followed yearly until 3 years of age. Result showed that of the 423 infants, 72 had hemoglobin level ≤ 11 g/dL, among which 55% had normal iron level. There was significant association between hemoglobin level and TLR1–2, and 4 induced IL-6 (p = 0.04, 0.02) and that of TLR4 stimulated TNF-α response (p = 0.04). Children with anemia had higher nasopharyngeal colonization with Moxarella catarrhalis. Clinical analysis did not show anemia to be associated with infectious morbidity. However, children who developed LRTIs had mean lower ferritin levels. We speculated that iron might be the key factor related to infectious morbidity. Thus, to investigate the role of anemia in infectious diseases, it is important to first consider the prevalence of iron deficit, since the incidence of iron deficiency-induced anemia may vary among different regions.
Highlights
Anemia is a major public health problem that occurs more prevalently in young children and pregnant women
Results from current study showed that infant anemia was associated with decreased pro-inflammatory cytokine responses to TLR1-2 and TLR4 stimulation, as well an increased prevalence of nasopharyngeal colonization with M. catarrhalis
In a large prospective clinical trial, provision of iron at 6 months of age was associated with decreased risk of anemia, the incidence of infectious diseases such as bloody diarrhea and acute respiratory illness were inadvertently increased following iron supplementation[16]
Summary
Anemia is a major public health problem that occurs more prevalently in young children and pregnant women. The causes of anemia may vary by age Those occurring in early childhood include iron deficiency, concurrent viral or bacterial infection, blood loss due to trauma or gastrointestinal bleeding, disorders of hemoglobin structure (thalassemia, sickle cell disease, spherocytosis), enzyme defects (G6PD or pyruvate kinase deficiency), micronutrient deficiency such as zinc or copper, and rare causes such as neoplastic diseases, immune-mediated, parasitic infestations, or lead poisoning. In-vitro tests have found iron to play an important role in human defense against infections, in developed countries, only around 50% of infant anemia was caused by iron deficiency, the association between anemia, whatever the etiology, and human infectious morbidity remained to be further explored. We aimed to investigate if infant anemia (with or without iron-deficiency) was associated with altered innate immune cytokine response, modifications in nasopharyngeal bacterial colonization rate, and subsequent infectious outcome in young children
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