Increased serum hepcidin and alterations in blood iron parameters associated with asymptomatic P. falciparum and P. vivax malaria.
BACKGROUND
Asymptomatic Plasmodium spp. infections and anemia are highly prevalent conditions in tropical regions. We studied whether asymptomatic parasitemia induces hepcidin- and/or cytokine-mediated iron maldistribution and anemia.


METHODS
A group of 1197 Indonesian schoolchildren, aged 5-15 years, were screened by microscopy for the presence of parasitemia. Concentrations of hemoglobin, serum hepcidin and parameters of iron status and inflammation were determined at baseline and 4 weeks after antimalarial treatment.


RESULTS
Asymptomatic P. falciparum and P. vivax parasitemia were detected in 73 (6.1%) and 18 (1.5%) children, respectively, of whom 84% and 83% had a C-reactive protein concentration below 5 mg/L. Children with P. falciparum or P. vivax parasitemia had significantly lower hemoglobin concentrations than 17 aparasitemic controls (12.6 and 12.2 g/dL versus 14.4 g/dL; P<0.01), together with significantly higher serum hepcidin concentrations (5.2 and 5.6 nM versus 3.1 nM; P<0.05). The latter was associated with signs of iron maldistribution with higher ferritin concentrations and lower values of serum iron concentration, transferrin saturation and erythrocyte mean cell volume. Concentrations of growth differentiation factor 15 were similar across groups. Antimalarial treatment partly reversed these abnormalities and led to a significant increase in hemoglobin concentration.


CONCLUSIONS
Asymptomatic malarial parasitemia is associated with increased hepcidin concentrations and anemia, in the absence of a manifest acute phase response. Prolonged iron maldistribution may be an underestimated cause of anemia. Screening for parasitemia should be performed before starting iron supplementation, as iron therapy may be less effective and even hazardous in these circumstances.
Department of Internal Medicine, Radboud University Medical Center PO Box 9101, 6500 HB, Nijmegen, the Netherlands. q.demast@aig.umcn.nl
Quirijn
Q
de Mast
Din
D
Syafruddin
Stephan
S
Keijmel
Teun Olde
TO
Riekerink
Oktavian
O
Deky
Puji B
PB
Asih
Dorine W
DW
Swinkels
Andre J
AJ
van der Ven
D000293:Adolescent; D000740:Anemia / Q000469:parasitology; D023181:Antimicrobial Cationic Peptides / Q000097:blood*; D002648:Child; D064451:Hepcidins; D006801:Humans; D007214:Indonesia; D007501:Iron / Q000097:blood*; D016778:Malaria, Falciparum / Q000097:blood*; D016780:Malaria, Vivax / Q000097:blood*; D008403:Mass Screening / Q000379:methods; D018512:Parasitemia / Q000097:blood
D023181:Antimicrobial Cationic Peptides; C578702:HAMP protein, human; D064451:Hepcidins; D007501:Iron