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Iron and infection in the tropics: paediatric clinical correlates
1Liverpool School of Tropical Medicine, UK. stephen.oppenheimer@paediatrics.oxford.ac.uk
Insights
Iron supplementation in children can worsen infections like malaria, especially when immunity is low. Careful dosing and timing are crucial for safe iron therapy and food fortification programs.
Area of Science:
- Public Health
- Nutritional Immunology
- Pediatric Infectious Diseases
Background:
- Iron deficiency is a global child health issue, addressed by supplementation and fortification.
- The interplay between iron and infection necessitates clear guidelines for iron interventions.
- Iron overload can increase susceptibility to infections, with varied mechanisms.
Purpose of the Study:
- To review the complex relationship between iron therapy and infection risk in children.
- To highlight the need for evidence-based guidelines for iron supplementation and food fortification.
- To discuss the impact of iron interventions on specific infections like malaria and respiratory diseases.
Main Methods:
- Literature review of studies on iron supplementation, food fortification, and iron chelation.
- Analysis of clinical trial data and observational studies concerning iron and infection.
- Examination of factors influencing iron-infection interactions, including immunity and endemic diseases.
Main Results:
- Parenteral iron in Papua New Guinea linked to increased malaria and respiratory illness in infants.
- Oral iron in African studies showed adverse effects, particularly in immunocompromised children with therapeutic doses.
- Iron chelation therapy demonstrated protection against malaria but potential risk for fungal and Yersinia infections.
Conclusions:
- Iron interventions require careful consideration of endemic disease prevalence, host immunity, and age.
- Optimizing the timing and dosage of oral iron is essential for safe and effective recommendations.
- Balancing iron supplementation benefits against infection risks is critical for public health programs.
Abstract:
Iron deficiency is prevalent in children worldwide. Programmes of presumptive therapy, mass supplementation and food fortification have been introduced in many countries. The continuing unresolved debate over the interaction of iron and infection in the clinical setting indicates the need for firm guidelines for these practices. Iron overload is associated with increased susceptibility to certain infections, although the exact mechanisms may vary with the main pathology. Iron treatment has been associated with acute exacerbations of infection, in particular malaria. In Papua New Guinea parenteral iron was associated with increased rates of malaria and increased morbidity due to respiratory disease in infants but not in school children. Several subsequent studies in Africa using oral iron showed deleterious effects. In most instances cited, immunity was compromised, and therapeutic doses of oral iron were used. Knowledge of malarial endemicity, immunity with respect to age and the prevalence of haemoglobinopathies is important in planning interventions. A fine balance needs to be struck in the timing and dose of oral iron if informed recommendations are to be made. In parallel with supplementation studies, the effects of iron chelation on infection are being reported increasingly. Such therapy is clearly protective against malaria and some other infections but may predispose to fungal and Yersinia infections.