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How Severe Anaemia Might Influence the Risk of Invasive Bacterial Infections in African Children

1
Kenya Medical Research Institute (KEMRI) Center for Geographical Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kilifi P.O. Box 230-80108, Kenya
2
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
3
Department of Infectious Diseases and Institute of Global Health Innovation, Imperial College, London W2 1NY, UK
4
Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
*
Authors to whom correspondence should be addressed.
Int. J. Mol. Sci. 2020, 21(18), 6976; https://doi.org/10.3390/ijms21186976
Received: 4 August 2020 / Revised: 4 September 2020 / Accepted: 15 September 2020 / Published: 22 September 2020
Severe anaemia and invasive bacterial infections are common causes of childhood sickness and death in sub-Saharan Africa. Accumulating evidence suggests that severely anaemic African children may have a higher risk of invasive bacterial infections. However, the mechanisms underlying this association remain poorly described. Severe anaemia is characterized by increased haemolysis, erythropoietic drive, gut permeability, and disruption of immune regulatory systems. These pathways are associated with dysregulation of iron homeostasis, including the downregulation of the hepatic hormone hepcidin. Increased haemolysis and low hepcidin levels potentially increase plasma, tissue and intracellular iron levels. Pathogenic bacteria require iron and/or haem to proliferate and have evolved numerous strategies to acquire labile and protein-bound iron/haem. In this review, we discuss how severe anaemia may mediate the risk of invasive bacterial infections through dysregulation of hepcidin and/or iron homeostasis, and potential studies that could be conducted to test this hypothesis. View Full-Text
Keywords: severe anaemia; bacteraemia; iron; hepcidin; Salmonella; E. coli; Staphylococcus; Haemophilus; Streptococcus; Mendelian randomization severe anaemia; bacteraemia; iron; hepcidin; Salmonella; E. coli; Staphylococcus; Haemophilus; Streptococcus; Mendelian randomization
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Abuga, K.M.; Muriuki, J.M.; Williams, T.N.; Atkinson, S.H. How Severe Anaemia Might Influence the Risk of Invasive Bacterial Infections in African Children. Int. J. Mol. Sci. 2020, 21, 6976.

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