Hookworm and S. haematobium infections, unlike Afebrile P. falciparum Malaria, do not Impair Intestinal Iron Absorption

Abstract

Objectives: In sub-Saharan Africa, parasitic diseases and low intake of bioavailable iron are the main causes of anemia. Anemia is further increased by inflammation during malarial infections blocking iron recycling and decreasing iron absorption. The influence of hookworm and Schistosoma infections on iron absorption and recycling is not known. Our objectives were to compare the influence of malaria, hookworm, and Schistosoma infections on inflammation, iron absorption and iron incorporation. Methods: Ivorian adolescents (12-17 years) presenting with a single infection of afebrile P. falciparum, hookworm or S. haematobium consumed 200 mL of test syrup containing 3 mg iron as ferrous sulfate labeled with 57Fe. Fractional absorption of the stable iron isotope was measured during infection and two weeks after treatment when subjects were free of infection. Erythrocyte incorporation of intravenous iron labeled with 58Fe and inflammation biomarkers were also measured. Results: Geometric mean iron absorption was 12.1% (95% CI: 9.2 - 18.0) during afebrile P. falciparum infection and increased to 23.6% (95% CI: 19.6 - 28.5) (P < 0.05) after treatment. Inflammation biomarkers were elevated during malarial infection and decreased after treatment. Light to moderate hookworm and S. haematobium infections did not increase inflammation and did not influence iron absorption (P > 0.05). Erythrocyte incorporation of intravenous iron was not affected by P. falciparum, hookworm or S. haematobium infections (P > 0.05). Conclusions: Unlike afebrile P. falciparum infection, light to moderate hookworm and S. haematobium infections do not lead to low-grade inflammation, and do not decrease iron absorption.