Iron homeostasis and cytokine responses in Gabonese children with febrile illness.

BACKGROUND

Iron deficiency, anemia, and infectious diseases contribute largely to the disease burden among children in Sub-Saharan Africa. Accurate assessment of iron status and its relationship with infections is essential for refining iron supplementation strategies.

METHODS

We report retrospectively analyzed data from a cross-sectional study of children aged 2-17 years with acute febrile illness (fever ≤7 days) in Lambaréné, Gabon (NCT03047642). Symptom-based microbiological testing identified infection etiology. Blood count, C-reactive protein, iron parameters, and cytokines levels assessed iron deficiency, anemia, and immune activation.

RESULTS

Among 415 screened children with acute febrile illness, hemoglobin and iron parameters are available in 197. Of those, 145 (73.6%) are anemic: 53 (36.6%) show anemia of inflammation (AI), 11 (7.6%) iron-deficiency anemia (IDA), and 29 (20.0%) combined AI/IDA. Others are categorized as multifactorial, with mostly microcytic anemia, transferrin saturation (TSAT) ≥ 20% and varying ferritin levels. TSAT is negatively associated with IL-10, IL-6, and IL-2 in the malaria-positive group, with IL-10 also showing a positive correlation with parasitemia counts. In malaria-negative children with undetermined pathogens, IFN-γ and IL-4 levels are positively associated with TSAT and ferritin.

CONCLUSIONS

These findings highlight iron dyshomeostasis in infectious diseases and confirm associations between iron availability and immune activation to causative pathogens.