Associations of bacterial enteropathogens with systemic inflammation, iron deficiency, and anemia in preschool-age children in southern Ghana

Abstract

Anemia remains a pervasive public health problem among preschool-age children in Ghana. Recent analyses have found that anemia in Ghanaian children, particularly in Southern regions, is largely attributable to infectious causes, rather than nutritional factors. Infections with enteropathogens can reduce iron absorption and increase systemic inflammation, but few studies have examined direct links between enteropathogens and anemia. This study investigated associations between detection of individual bacterial enteropathogens and systemic inflammation, iron deficiency, and anemia among 6- to 59-month-old children in Greater Accra, Ghana. Serum samples were analyzed from a cross-sectional sample of 262 children for concentrations of hemoglobin (Hb), biomarkers of systemic inflammation [C-reactive protein (CRP) and α-1-acid glycoprotein (AGP)], and biomarkers of iron status [serum ferritin (SF) and serum transferrin receptor (sTfR)]. Stool samples were analyzed for ten bacterial enteropathogens using qPCR. We estimated associations between presence of each enteropathogen and elevated systemic inflammation (CRP > 5 mg/L and AGP > 1 g/L), iron deficiency (SF < 12 μg/L and sTfR > 8.3 mg/L) and anemia (Hb < 110 g/L). Enteropathogens were detected in 87% of children’s stool despite a low prevalence of diarrhea (6.5%). Almost half (46%) of children had anemia while one-quarter (24%) had iron deficiency (low SF). Despite finding no associations with illness symptoms, Campylobacter jejuni/coli detection was strongly associated with elevated CRP [Odds Ratio (95% CI): 3.49 (1.45, 8.41)] and elevated AGP [4.27 (1.85, 9.84)]. Of the pathogens examined, only enteroinvasive Escherichia coli/Shigella spp. (EIEC/Shigella) was associated with iron deficiency, and enteroaggregative Escherichia coli (EAEC) [1.69 (1.01, 2.84)] and EIEC/Shigella [2.34 (1.15, 4.76)] were associated with anemia. These results suggest that certain enteroinvasive pathogenic bacteria may contribute to child anemia. Reducing exposure to enteropathogens through improved water, sanitation, and hygiene practices may help reduce the burden of anemia in young Ghanaian children.

C-reactive protein and high-sensitivity C-reactive protein levels in asymptomatic intestinal parasite carriers from urban and rural areas of Gabon

“…Thus they should share comparable levels of exposure to some NCD risk factors. Moreover, the analysis performed here are comparable to those in other reports regarding the relationship between infectious diseases or agents and our studied inflammation biomarkers [8,34].…”

“…These pathogenic species, as well Blastocystis spp., can cause inflammation [11]. Globally, enteropathogens reduce iron absorption and increase systemic inflammation [8,33]. The trend toward a higher risk of high biomarker levels in case of helminth-protozoa coinfection confirms the additional impact of protozoa on systemic inflammation.…”

“…Cardiovascular diseases (CVD), type 2 diabetes, and metabolic syndrome are associated with persistent or chronic inflammation, even low-grade, by inducing or increasing insulin resistance and atherosclerosis [3,4]. Infectious diseases, either bacterial, viral or parasitic, when repeated or chronic, generally maintain systemic chronic inflammation, which can increase the susceptibility to age-related inflammatory status and chronic immune system activation, both of which are recognized as cardiometabolic diseases risk factors (CMDRF) [5][6][7][8]. Furthermore, alteration of the gut microbiota, which is correlated with cardio-metabolic diseases, can be caused by parasite-induced alteration of the microbial community during chronic infection [9,10].…”

The Diversity of Escherichia coli Pathotypes and Vaccination Strategies against This Versatile Bacterial Pathogen

“…Multiple factors including T3SS effectors such as IpaB and IpaC, which are used for phagosomal escape by bacteria; host factors such as Rab5 and Rab11; and other cytosolic access factors utilized by intracellular bacterial pathogens are involved in rupturing the endocytic vacuole in less than 10 min following cell entry [ 3 , 71 , 209 ]. After this, bacteria multiply inside cells and invade and damage surrounding epithelial cells that results in Shigellosis-like symptoms such as watery diarrhea with mucus, with leukocytes and blood in the stool, abdominal pain with cramps and tenesmus, fever, and systemic toxicity as well [ 209 , 210 , 211 ].…”

Prevalence, Risk Factors and Patterns of Different Underlying Enteropathogens in Pediatric Patients

“…Using Kato Katz techniques, helminths were identified in the stool samples. After preparing duplicate thick smears of each stool sample, two laboratory personnel independently examined the slides for helminth eggs using microscopy 10 .…”