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.